
Gass'KA 105/ 

Book '1^4 

1224 



TEXT-BOOK 



o'/ 






MEDICAL JURISPRUDENCE 



AND 



TOXICOLOGY 



/ 




By JOHN J. REESE, M.D., 



PROFESSOR OF MEDICAL JURISPRUDENCE AND TOXICOLOGY IN THE UNIVERSITY OF 

PENNSYLVANIA; VICE-PRESIDENT OF THE MEDICAL JURISPRUDENCE SOCIETY OF 

PHILADELPHIA ; PHYSICIAN TO ST. JOSEPH'S HOSPITAL ; MEMBER 

OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA; 

CORRESPONDING MEMBER OF THE NEW 

YORK MEDICO-LEGAL SOCIETY. 







O.e- \n- 



.*'^.!-''i "'vT 



PHILADELPHIA : 

P. BLAKISTON, SON & CO., 

I0I2 WALNUT STREET, 
1884. 



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Entered, according to Act of Congress, in the year 1884, by 

P. BLAKISTON, SON & CO., 

in the Office of the Librarian of Congress, at Washington, D. C. 



PREFACE. 



This Text-book has been written more particularly to 
meet the wants of students of Legal Medicine. The author 
is aware that the field has already been occupied by able 
and popular treatises on medical jurisprudence, well known 
to the professions of medicine and law ; but an experience 
of over twenty years, as a public teacher of this branch of 
science, has convinced him that students in both these 
professions, who desire to acquire a knowledge of medical 
jurisprudence, are too often deterred from their purpose by 
being confronted by the ponderous works of recognized 
masters, extending to three, and even six large octavo 
volumes. 

To avoid the above objection, the author of the present 
work has endeavored to condense in a handy volume all 
the essentials of the science, and to present the various 
topics in a simple and familiar style, giving greater promi- 
nence, of course, to those of the greatest practical im- 
portance. 

The subject of Toxicology occupies, as was proper, a 
considerable space, and has been carefully prepared ; special 
attention being bestowed upon the most important poisons — 
such as Arsenic, Strychnine, Opium, Prussic Acid, etc. 

The chapter on Insanity is as full as the size of the 
volume would justify, and will be found, it is hoped, to 

iii 



IV PREFACE. 

contain all the essential medico-legal points pertaining to 
this subject. 

The author has not hesitated to avail himself freely of 
the materials so abundantly presented in the elaborate and 
classic works of Casper, Taylor, Beck, Wharton and Stille, 
Tidy, Guy, Tardieu, and others ; always desiring to give 
due credit to the authority quoted, and usually doing so at 
the time ; and he would embrace this opportunity to 
express his obligations to these authorities. He is sincerely 
desirous to encourage an increasing interest in the students 
of both medicine and law for that most important, but too- 
much neglected, subject — Forensic Medicine; and he would 
indulge the hope that the present treatise, in its unpre- 
tentious size and style, may aid in so doing. 
Philadelphia, September, i88/f.. 



TABLE OF CONTENTS. 



CHAPTER I. 

Introduction. page 

Definition. — Importance to Students of Medicine and Law. — Order of 
Proceeding in a Medico-legal Case. — The Coroner's Inquest. — The 
Criminal Court. — Medical Evidence. — Medical Experts, — Dying 
Declarations. ............ 9 

CHAPTER II. 
Phenomena and Signs of Death. 
Section I. — Molecular and Somatic Death. — The Immediate Cause of 
Death to be found in either the Heart, Lungs or Brain. — Post-mortem 
Evidences of these. — The "Signs of Death." — Cessation of Respiration 
and Circulation. — Changes in the Eyes. — Pallor of the Body. . . -25 
Section II. — Signs of Death continued. — Loss of Animal Heat. — Post- 
mortem Caloricity. — Rigor Mortis. — Post-mortem Lividity, or Suggillation 32 
Section III. — Signs of Death continued. — Putrefaction. — External and 
Internal Signs. — Adipocere. — Mummification. — How long since the 

Death? 41 

CHAPTER III. 
Medico-legal Investigations. — The Post-mortem. 
Responsibility involved. — Accuracy and Method necessary. — Examination 
of the surroundings. — External examination of the Body. — Internal ex- 
amination. — Details of the Examination. — Measurements and Weights. — 

Notes 56 

CHAPTER IV. 
Presumption of Death and of Survivorship. 
Cases involving Presumption of Death and of Survivorship. — French Law 
of Survivorship. — Probabilities afforded by Age, Sex, and Mode of Death. ^ 6'^ 
CHAPTER V. 
Personal Identity. 
Section I. — Important Medico-legal bearings. — I. Identification of the 
Living. — Personal Appearance. — Peculiar bodily marks. — Remarkable 
Cases. ............. 69 

V 



VI TABLE OF CONTENTS. 

PAGE 

Section II. — II. Identification of the Dead. — Mutilated Remains. — Identi- 
fication by means of the Skeleton, as to Age, Sex, and Stature. — Rules of 
Proportion. — Fractures, Deformities, and Callus. — Age of Bones. — Ex ■ 
amination of Hairs and Fibres. ........ 7^ 

CHAPTER VI. 
The Causes Producing Violent Death. 
Section I. — Death from Wounds. — Definition of a Wound. — Danger of. — 
Examination of the Body. — Absence of external marks of violence. — 
Wounds made before and after death. — Hemorrhage. — Ecchymoses. — 
Classification. — Homicidal, Suicidal and Accidental Wounds. . . .92 

Section II. — Gunshot Wounds. — Differ from other wounds. — Deflection 
of the Ball. — Wounds made by Shot, Wadding and Powder. — Wounds of 
the Head, Neck, Spine, Chest and Abdomen. ...... 107 

CHAPTER VII. 
Examination of Blood Stains. 
Importance of their identification. — Three methods of identifying. — i. The 
Chemical Tests. — 2. The Microscopic Test. — 3. The Spectroscopic Test. 

— Blood Crystals 121 

CHAPTER VIII. 
Burns and Scalds. 
Definition. — Classification. — Symptoms. — Cause of Death. — Post-mortem 
appearances. — Burns made before and after death. — Accidental, Suicidal 
and Homicidal Burns. — Spontaneous Combustion .134 

CHAPTER IX. 
Death from Different Forms of Asphyxia. 
Section I. — Death from Suffocation. — Accidental, Suicidal and Homicidal 
Suffocation. — Post-mortem signs, ........ 143 

Section II. — Death by Strangulation. — Modes of Strangulation. — External 
signs. — Internal lesions. — Accidental, Suicidal and Homicidal Strangu- 
lation. — Mark of the Cord, 146 

Section III. — Death by Hanging. — Cause of Death. — Post-mortem appear- 
ances. — Cord marks. — Generally suicidal, . . . . . .151 

Section IV. — Death by Drowning. — Mode of Death. — Time required. — 
Signs of Death, external and internal. — Accidental, Suicidal and Homi- 
cidal Drowning, 156 

CHAPTER X. 

Death by Lightning. 

Medico-legal relations. — Mode of Death. — Post-mortem signs, . . .166 



TABLE OF CONTENTS. Vll 

CHAPTER XL 

Death from Heat and Cold. 

Diverse effects of Heat upon the body.— Post mortem appearances.— 
Effects of Cold. — Post mortem signs, 170 

CHAPTER Xn. 
Death by Starvation. 

Accidental, Homicidal and Suicidal Starvation.— Pretended cases of volun- 
tary starvation.— Symptoms, and Post-mortem signs.— Medico-legal rela- 
tions, 

CHAPTER Xni. 
Death from Poisoning. — Toxicology. 

Section L— Definition of a Poison.— Effects.— Proofs of Absorption.— 
Subsequent disposition of the Poison.— Elimination.— Cause of Death.— 
Circumstances modifying their action.— Antagonism of Poisons, . .178 

Section II.— Evidences of Poisoning.— i. Evidences from Symptoms.— 2. 
From post-mortem lesions.— 3. Chemical Analysis.— Post-mortem Imbi- 
bition of Poisons.— Rules in performing a toxicological analysis.— 4. 
Physiological experiments.— 5. Circumstantial Evidence.— Medico-legal 
conclusions. — Classification, jg5 

CHAPTER XIV. 
Poisoning by the Mineral Acids. 

Certain common symptoms.— Post-mortem appearances. —Treatment. 

Chemical analysis.— Toxicological examination for the different Acids, 202 
CHAPTER XV. 
Poisoning by the Alkalies and their Salts. 
Section I.— Potassa, Soda, and Ammonia.— Similarity of effects.— Symp- 
toms.— Fatal Dose.— Treatment.— Post-mortem appearances.— Chemical 

analysis. ^je 

Section II.— Poisoning by the Alkaline and Earthy Salts.— Nitrate of 
Potassium.— Bitartrate of Potassium.— Sulphate of Potassium.— Alum.— 
Chlorinated Potassium and Sodium.— Salts of Barium 220 

CHAPTER XVI. 
Irritants Possessing Remote Specific Properties. 
Section I.— Poisoning by Phosphorus.— Symptoms.— Fatal Dose.— Treat- 
ment.— Morbid appearances.— Diagnosis. — Chemical analysis.— Amor- 
phous Phosphorus 224 

Section II.— Poisoning by Iodine, Bromine, and Chlorine. . . .234 



Vlll TABLE OF CONTENTS. 

PAGE 

CHAPTER XVII. 
Poisoning by Arsenic. 

Metallic Arsenic. — Arsenious Acid. — Properties. — Symptoms. — Chronic 
Poisoning. — Fatal Dose. — Treatment. — Post-mortem signs. — Chemical 
analysis. — Toxicological examination. — Other Preparations of Arsenic. . 238 

CHAPTER XVIII. 
Poisoning by Antimony (Tartar Emetic). 
Properties of Tartar Emetic. — Symptoms. — Fatal Dose. — Post-mortem ap- 
pearances, — Slow Poisoning. — Chemical analysis. — Toxicological exami- 
nation. ............. 262 

CHAPTER XIX. 
Poisoning by Mercury (Corrosive Sublimate). 

Corrosive Sublimate. — Properties. — Symptoms. — Post-mortem appearances. 
— Fatal Dose. — Antidotes. — Chemical analysis. — Toxicological examina- 
tion. — Salivation, ........... 273 

CHAPTER XX. 
Poisoning by Lead. 

Frequency of Chronic Poisoning, — Acetate of Lead, — Symptoms. — Treat- 
ment, — Post-mortem appearances, — Painters' Colic, — Lead Palsy, — Toxi- 
cological examination. .......... 285 

CHAPTER XXI, 
Poisoning by Copper. 

Accidental Poisoning. — Salts of Copper. — Fatal Dose. — Treatment. — Morbid 
appearances, — Chemical analysis, — Toxicological examination. . . 294 

CHAPTER XXII. 

Poisoning by Zinc, Bismuth, Tin, Iron and Chromium. 

Section I, — Poisoning by Zinc. . . . . . . . ' 301 

Section II. — Poisoning by Bismuth 305 

Section III. — Poisoning by Tin, Iron and Chromium. .... 306 

CHAPTER XXIII. 
Vegetable and Animal Irritants. 

Section I. — Poisoning by Oxalic Acid. — Sources of the Acid in Nature. — 
Symptoms. — Fatal Dose. — Treatment. — Morbid appearances. — Chemical 
analysis. — Toxicological examination. — Binoxalate of Potassium. . , 308 

Section II. — Poisoning by Carbolic Acid, . . . . . '315 



TABLE OF CONTENTS. IX 

PAGE 

Section III. — Poisoning by Croton Oil, Elaterium, Castor Oil Beans, 
Colchicum and Savin. . . . . . . . . . -317 

Section IV. — Poisoning by the Hellebores. — Veratria. — Yellow Jessamine. 
— Poisonous Mushrooms. 320 

CHAPTER XXIV. 
Animal Irritants. 

Poisoning by Cantharides. — Poisonous Animal Food. — Sausage Poison. — 
Trichinosis. — Cheese Poison. — Poisonous Fish. — Putrescent Food. — Pois- 
oned Flesh 325 

CHAPTER XXV. 
Class II. Neurotic Poisons. 

Section I. — Narcotics. — Poisoning by Opium. — Nature of Opium. — Pois- 
onous Symptoms. — Fatal Period and Dose. — Treatment. — Morphia. — 
Properties. — Tests. — Meconic Acid. — Tests. — Toxicological examination. 330 

Section II. — Poisoning by Alcohol. — Acute Alcoholism. — Symptoms. — 
Post-mortem lesions. — Chemical analysis. — Detection in the Tissues. . 341 

CHAPTER XXVI. 
2. Anaesthetics. 

Poisoning by Ether, Chloroform, and Chloral Hydrate. .... 345 

CHAPTER XXVII. 
Spinal Neurotics. — Poisoning by Nux Vomica. — Strychnia. 
Nux Vomica. — Strychnia. — Effects. — Fatal Dose. — Treatment. — Post-mor- 
tem lesions. — Diagnosis. — Chemical analysis. — Interferences. — Physio- 
logical Test. — Toxicological examination, . . . . . '351 

CHAPTER XXVIII. 
Cerebro-spinal Neurotics. — (i) Deliriants. 
Section I. — Poisoning by Belladonna.— Symptoms. — Atropia. — Fatal Dose. 
— Treatment. — Post-mortem appearances. — Chemical analysis. — Toxico- 
logical examination. .......... 373 

Section II. — Poisoning by Stramonium, Hyoscyamus and Solanum. . . 376 

CHAPTER XXIX. 
2. Depressants. 

Section I. — Poisoning by Tobacco and Lobelia. — Effects of Tobacco. — 
Post-mortem lesions. — Nicotina. — Properties. — Chemical reactions. — 
Toxicological examination. — Lobelia. ....... 380 



X TABLE OF CONTENTS. 

PAGE 

Section II. — Poisoning by Hemlock — Conia. — Symptoms. — Post-mortem 
appearances. — Conia. — Chemical reactions. — Toxicological examination. 
— Other poisonous Hemlocks. ........ 386 

Section III. — Poisoning by Aconite and Calabar Bean. — Properties of the 
Plant. — Effects. — Post-mortem appearances. — Aconitine. — Fatal Dose. 
— Treatment. — Chemical analysis. — Toxicological examination. — Calabar 
Bean. — Eserine 390 

CHAPTER XXX. 
(3) Asthenics. 

Section I. — Poisoning by Hydrocyanic Acid. — Natural Occurrence in 
Vegetables. — Pure and Officinal Acids. — Symptoms. — Fatal Period and 
Dose. — Treatment. — Post-mortem appearances. — Tests. — Toxicological 
examination. — Cyanide of Potassium, — Oil of Bitter Almonds. — Cherry- 
laurel Water. — Nitro-Benzole. 397 

Section II. — Poisoning by Digitalis. — Symptoms. — Post-mortem lesions. 
— Fatal Dose. — Digitaline. — Chemical analysis. — Toxicological exami- 
nation. — Case of De la Pomerais.— Poisoning by Cocculus Indicus. . . 409 

CHAPTER XXXI. 
The Alkaloids of Putrefaction. — Ptomaines. 

416 
CHAPTER XXXII. 
Feigned Diseases. 
Great variety of Simulated Diseases. — Fictitious and Factitious Diseases. — 
General Rules for Diagnosis. — Special Diagnosis. . . . . -419 

CHAPTER XXXIII. 
Pregnancy. 

Cases where it becomes the subject of Medico-legal Investigation. — Signs 
of Pregnancy, Uncertain and Certain. — Unconscious Pregnancy. — Preg- 
nancy in the Dead, .......... 432 

CHAPTER XXXIV. 
Criminal Abortion, or Foeticide. 

Definition. — Frequency of Abortion from Natural Causes. — Proofs that a 
Foetus has been destroyed. — Signs afforded by the Mother. — Age of the 
Foetus. — Means employed, . . . . . . . . .441 

CHAPTER XXXV. 
Infanticide. 
Section I. — Definition. — A Live Birth. — I. Questions relating to the 
Infant. — Was it born alive? — Signs of Death before birth. — i. Proofs of 
a Live Birth derived from the Lungs. — The Hydrostatic Test, . -455 



TABLE OF CONTENTS. XI 

PAGE 

Section II.— 2. Proofs of a Live Birth derived from the Organs of Circu- 
lation, and the Abdominal Organs. — Peculiarities of the Foetal Circula- 
tion. — Uncertainty of these signs. — Desiccation of the Umbilical Cord. — 
Proofs of a Live Birth from the Stomach and Intestines, .... 468 

Section III.— Cause of Death in the newborn child.— (i) Causes acting 
during Birth.— Compression of and by the Cord.— Protracted Delivery.— 
Debility, Hemorrhage, Fracture of Skull.— (2) Causes acting after 
Birth.— Congenital Malformation and Disease.— Exposure.— Improper 
Food. — Wounds and Injuries. — Suffocation. — Strangling. — Drowning. — 
Poisoning.— Accidental Causes.— Mode of conducting the Examination, . 473 

Section IV. — II. Questions relating to the Mother. — Signs of Delivery. — 
Early Signs. — Examination of the Milk. — Concealed Delivery. — Conceal- 
ment of Birth. — Pretended Delivery, 49^ 

CHAPTER XXXVI. 
Legitimacy. — Inheritance. 

Section I. — Medico-legal Importance. — Ordinary term of human gesta- 
tion. — Protracted gestation. — Argument from analogy of the Lower 
Animals. — Premature Delivery. — Early Viability of the Child. — Live 
Birth in Civil Cases, 49^ 

Section II. — Tenancy by Courtesy. — Laws concerning Legitimacy. — Pater- 
nity. — AffiHation. — Superfoetation. — Doubtful Sex in Hermaphroditism, . 504 

Section III. — Impotence. — SteriHty. — Impotence. — Causes. — Procreative 
Power of the Male. — Crypsorchides and Monorchides. — Sterility. — Procre- 
ative Power in theFemale. — Legal Decisions, 51 1 

CHAPTER XXXVII. 
Rape. 

Section I. — Legal Meaning. — Duty of the Examiner. — Rape on Children. — 
May be confounded with disease, . . . . . . . • 5^^ 

Section II. — Rape on Adult Women. — Possibility of, without consent. — 
If unconscious. — Effects of Ether. — Case of Co7n. v. Beale. — Evidences 
of Rape on Adults. — Condition of the Hymen. — Seminal stains. — Evi- 
dences of Rape on the Dead. — Unnatural Crimes. — Legal relations of 
Rape, 522 

CHAPTER XXXVIII. 
Insanity. 

Section I. — Medico-legal difficulties of Insanity. — Civil and Criminal 
Responsibility. — Legal Terms. — Illusions, Hallucinations and Delusions. — 
Concealment of Delusions. — Lucid Intervals. — Classification, . . . 535 



Xll TABLE OF CONTENTS. 

PAGE 

Section II. — (i) Defective Development of the Faculties. — Idiocy, Physi- 
cal marks of. — Pathological marks. — Imbecility. — Cretinism. — Legal re- 
lations of Idiocy and Imbecility, ........ 542 

Section III. — Lesions of the Mental Faculties subsequent to their devel- 
opment. — General Intellectual Mania — Symptoms. — Melancholia — 
Symptoms. — Partial Intellectual Mania. — Moral Mania. — Monomania. — 
Kleptomania. — Pyromania. — Dipsomania. — Responsibility of Drunkards. 
— Somnambulism, ........... 545 

Section IV. — Homicidal, Suicidal and Puerperal Mania, .... 552 

Section V. — Dementia. — General Paresis. — Post-mortem Lesions, . . 558 

Section VI. — Medico-legal relations of Insanity, — Deprivation of Liberty. 
— Signing Certificates of Insanity. — Testimony in Criminal Cases. — Testa- 
mentary Capacity. — Opinions in relation to Marriage, and Education of 
Children, ............ 566 

Section VII. — Criminal Responsibility. — The Plea of Insanity as a bar to 
capital punishment. — Importance of a correct understanding of the sub- 
ject. — A mere " Knowledge of Right and Wrong" not sufficient. — Condi- 
tion of the Will, or Self-Control, — Emotional Insanity, . . . -571 

Section VIII. — Simulated, or Feigned Insanity. — Pretended Insanity in 
Criminals. — Importance of ascertaining the motive. — Means taken to 
conceal the crime. — Mania, the form usually feigned, .... 576 

CHAPTER XXXIX. 
Medical Malpractice. 

Definition, — The Physician not an Insuror, — Certain established principles. 
— "Ordinary Skill." — Errors in judgment. — Frequency of civil suits. — 
Liability of Druggists, .......... 582 

CHAPTER XL. 
Life Insurance. 

Meaning of the Term. — Conditions of the Policy. — Concealment of Facts. — 
Relation of Intemperance and Suicide to Life Insurance, . . .591 

Appendix. — Corpus Luteum. 

599 
Index. 

601 



TEXT-BOOK 



MEDICAL JURISPRUDENCE 

AND 

TOXICOLOGY. 



CHAPTER I. 

DEFINITION. — IMPORTANCE TO STUDENTS OF MEDICINE AND LAW. — 
ORDER OF PROCEEDING IN A MEDICO-LEGAL C\SE. — THE CORO- 
NER'S INQUEST. — THE CRIMINAL COURT. — MEDICAL EVIDENCE. — 
MEDICAL EXPERTS. — DYING DECLARATIONS. 

Medical Jurisprudence, or Legal or Forensic Medicine, 
as it is sometimes named, may be defined to be the science 
which applies the knowledge of Medicine to the require- 
ments of Law. To aid in the discovery of truth, which is 
the great purpose of the Law, every department of human 
knowledge should be made to contribute, and Medicine 
among the rest. When certain cases are presented for legal 
decision, affecting the life or property of an individual, 
and these cases require for their proper elucidation an 
appeal to medical knowledge, they are termed medico-legal 
cases, and the science on which they are based is named 
Medical Jurisprudence. 

It should require no argument to show the importance 
of the knowledge of this science to the student and prac- 
titioner of both the professions of medicine and law. The 
former cannot entirely evade its claims, although he may 
7, 9 



10 MEDICAL JURISPRUDENCE. 

seek to do so, since the very nature of his profession, 
together with his assumed pubHc position as an accredited 
physician, renders him Hable at any moment to be con- 
fronted with a case involving the intricate questions of 
homicidal, suicidal, or accidental death ; of infanticide ; 
of criminal abortion ; of rape ; of drowning, and of numer- 
ous other similar cases, all of which, when they become 
the subjects of legal investigation, must necessarily depend 
for their proper elucidation, chiefly, if not solely, upon the 
physician who had previously given his professional at- 
tendance in the case, and who must subsequently give his 
evidence before the court and jury. How important, then, 
that the practitioner of medicine, even though he may have 
no special leaning towards legal medicine, should become 
acquainted at least with the general principles and leading 
facts of this science. A proper regard, both for his own 
professional reputation and the general interests of the 
community, should constrain him not to neglect so import- 
ant and practical a branch of knowledge. And as regards 
the profession of the law, it is difficult to understand how 
a criminal cause of any kind can be satisfactorily conducted 
without some knowledge . of medical jurisprudence, inas- 
much as criminal law is indissolubly connected with legal 
medicine. It is much to be regretted that many of the 
present generation of lawyers in this country, graduate in 
their profession without the slightest knowledge of medical 
jurisprudence. Indeed, strange as it may appear, it is 
entirely ignored in some of our law schools, whilst in 
others, although professedly taught, it is not made obliga- 
tory upon the student, and therefore is virtually disregarded. 
The consequence of such neglect must be either, that 
criminal law is entirely abandoned by many distinguished 
practitioners, causing such cases to fall into the hands of 



RELATION OF MEDICINE TO LAW. 11 

inferior persons, who are not always the best quahfied to 
conduct them ; or else, when a really important criminal 
case is undertaken, the lawyer finds himself compelled to 
cram for the occasion, and is subjected to no little annoy- 
ance, and loss of time, in preparing for the impending trial. 
In truth, in such cases he is necessarily obliged to depend 
almost exclusively upon his medical witnesses, both as to the 
general mode of developing his case, and especially as to the 
manner of questioning the expert witnesses on either side. 

The superficial observer is often surprised at the intimate 
relationship subsisting between the two great sciences of 
medicine and law. As has just been shown, numerous 
cases brought before a court and jury can only be settled 
by an appeal to medical knowledge ; sometimes it is to one 
department of medicine, and sometimes to another ; and it 
not infrequently happens that several branches of medical 
science may be simultaneously called into requisition, in 
order to aid the law in arriving at a proper decision. For ex- 
ample, — is the case one of suspected homicide, where a dead 
body has been discovered under suspicious circumstances ? 
Who but the skillful anatomist and pathologist, by a carefully 
conducted autopsy, can shed the requisite light upon it ? Is 
it a case of alleged rape, or criminal abortion, or infanticide? 
Who so well qualified to conduct the investigation as the 
well trained obstetrician ? Or is it a case involving the dark 
suspicion of criminal poisoning? Who shall impart the 
necessary information upon which may hang suspended 
the life or death of the accused, save he who is thoroughly 
acquainted with the mysteries of toxicology ? Thus it may 
happen that, in a multitude of cases, the well instructed prac- 
titioner of medicine, when called upon to act the part of the 
legal physician, may be obliged to bring into requisition all 
the various departments of his science. 



12 MEDICAL JURISPRUDENCE. 

It is, perhaps, as a medical witness, that medico-legal 
knowledge is of the most important service to the physician. 
After he has accomplished the investigation of the case be- 
fore him by a carefully conducted autopsy, or by a critical 
toxicological examination, with perhaps the aid of micros- 
copy, and by other methods of scientific research, there yet 
remains the all-essential duty of giving the results of his 
investigations to the court and jury, in the form oi evidence; 
and to be prepared to do this in the proper manner, consti- 
tutes the chief acquirement of the medical jurist. 

The Coroner's Inquest. — The first public duty imposed 
upon the legal physician is to testify before the Coroner's 
Inquest. In all civilized countries a special officer, named 
the coro7ier, is appointed to investigate the unknown, or 
unexplained causes of sudden death, whenever this occurs 
under suspicious circumstances. For example, a dead body 
is discovered on the highway or in some sequestered spot, 
with, or without marks of external violence, or it may have 
been dragged out of the river; the body of a new-born 
child has been found in a well or cesspool, or discovered 
floating in the water; a stranger is discovered, in the morn- 
ing, dead in bed, at some hotel, far distant from his home; 
or a person in apparent sound health suddenly drops dead 
in the street, or in his room. In all these, and analo- 
gous cases, the law very wisely provides that a careful in- 
vestigation shall be instituted, so as to ascertain whether the 
death was due to natural causes, or whether it was the re- 
sult of violence. If the latter, then the nature of this vio- 
lence, e.g. whether from a wound (gunshot or otherwise), 
a bludgeon, an axe, hammer, or other blunt weapon; or 
whether occasioned by a fall. In the absence of all external 
marks of violence, — then, might the death not have been pro- 



THE CORONERS INQUEST. lo 

duced by poison? In each one of these cases, the farther 
question must be solved — was the death homicidal, suicidal, 
or accidental? 

The coroner's jury usually consists of six men (the 
number is not definitely fixed in this country), who are 
mostly selected from the neighborhood where the inquest 
is held. Their duty consists in (i) viewing the body and 
establishing its identity, and (2) in holding the inquest, 
which is a sort of petty court, wherein inquiry is made as 
to the cause of death, and (in a case of homicide) to ascertain, 
if possible, the guilty culprit. For this purpose, witnesses 
duly subpoenaed and sworn are examined, and the medical 
man who has performed the post-mortem examination 
(whether he be the coroner's recognized physician, or some 
other who has been specially appointed for this purpose) 
now makes his detailed report, and gives his opinion as to 
the real cause of death. The jury having heard the evi- 
dence, and consulted together, bring in their verdict, which 
is usually in accordance with the report of the medical 
officer. In some cases, particularly in cities, where the 
coroner has one or more specially appointed physicians, it 
is not considered necessary that the jury should personally 
view the body before holding the inquest ; it being regarded 
as sufficient that the body has been properly identified by 
the examining physician, and the autopsy carefully made, 
and the result duly reported. 

It will be observed that the special duty of the coroner's 
inquest is to discover the real cause of death; usually it 
does not fall within his province to discover the person who 
caused it. Nevertheless, it does sometimes happen that in 
the course of the investigation, suspicion may so strongly 
point to some particular individual, as to warrant the 
coroner to commit him to prison, to await further investiga- 



14 MEDICAL JURISPRUDENCE. 

tion. The usual verdict in cases of violent death (shown 
to have been neither suicidal nor accidental) is, that of 
murder, or manslaughter, against some person, known or 
unknown. 

As the post-mortem examination is an inseparable part 
of the coroner's inquiry, and, in fact, constitutes its most 
important factor, it is indispensable that it should be per- 
formed in the most careful and thorough manner; and no 
one is fit to undertake it but a skilled anatomist and 
pathologist. The medical man should never permit himself 
to be hurried in this work ; he should allow himself ample 
time, and always perform the autopsy by daylight, if pos- 
sible, inasmuch as he might fail to distinguish certain alter- 
ations of color by artificial light. When it is remembered 
that the most serious issues may be at stake — even those of 
life and death- — it will be acknowledged that the utmost 
caution should be exercised in conducting the autopsy. 
There may be cases, involving strong suspicion of murder, 
where it might be deemed advisable that the post-mortem 
examination should be performed by two independent ex- 
perts, in order to avoid the imputation of ex parte influence. 
One of these medical examiners should represent the State, 
and the other the accused. 

In giving his evidence before the coroner's jury the medi- 
cal man should not undervalue the situation. Although 
the inquest be held in some remote hovel or barn, and the 
jury be composed of rude, illiterate persons, he should not 
fail to remember that his testimony is all taken down by 
the proper officer, and that it will surely confront him at 
the approaching trial. This fact should alone be sufficient 
to impress upon him the seriousness of the occasion, and 
remind him of the importance of drawing up his report with 
due care and accuracy. 



MEDICAL EVIDENCE. 15 

TJie Criminal Court. — After the coroner's inquest the 
case (if a criminal one) is sent to the Grand Jury, who 
institute a prehminary examination, and either ignore it al- 
together, or else find a true bill. In the latter event, the case 
next comes before the judge and petty jury, for trial. To 
this trial the medical witness is summoned by a subpoena, 
which he cannot evade, but which it is his duty to obey. 
Before this court and jury, he will undergo a most strict and 
impartial examination as to his opinion of the cause of death, 
and the reasons on which this opinion is founded. He will 
be questioned most closely, in the cross-examination, as to 
his professional knowledge and acquirements, the extent of 
his opportunities for making such investigations as the one 
now pending, the accuracy of his post-mortem, or toxico- 
logical examination, the modes of distinguishing between 
wounds made before and after death, the method of dis- 
criminating between the effects of poisons and of disease, the 
danger of confounding these latter together, the liability to 
mistake in chemical results, and a hundred other matters, 
which will annoy and confuse the medical witness to no 
small degree, unless he be prepared beforehand, by his 
thorough medico-legal knowledge and training. A medical 
witness so properly fortified, need have no fear for himself; for, 
as he goes upon the stand honestly, to testify to the truth, 
"he need only," in the language of the late Professor Tay- 
lor, "bear in mind two considerations: first, that he should 
be thoroughly prepared on all points of the subject on 
which he is to give evidence; and secondly, that his de- 
meanor should be that of an educated gentleman, and suited 
to the serious occasion on which he appears." 

In the matter of Medical Evidence there are several points 
that require a brief notice here. After opening the case 
before the court, the prosecuting attorney, or some one 



IG MEDICAL JURISPRUDENCE. 

associated with him in the prosecution, calls the witnesses 
and examines them "according to the rules of evidence;" 
this is technically called the exaiiiinatioji iji chief. The 
*' rules of evidence " prohibit counsel, in the examination in 
chief, from putting leading questions to the witness, i. e., 
questions that suggest their own answers; and for the reason 
that the witness may be supposed to be willing to say any- 
thing favorable suggested to him by his own counsel, and 
to repress anything unfavorable. The replies of the witness, 
however, should always be given with equal clearness and 
precision, to both the counsel for the defence, and for the 
prosecution. 

The cross-examination next follows : this is conducted by 
the counsel for the prisoner, and is especially aimed at contra- 
dicting and overthrowing, if possible, the witness's previous 
testimony. To this end, the counsel plies the witness with 
questions which are strongly " leading," and such as may 
most strongly suggest any facts or circumstances which 
he had previously withheld, and which may appear favorable 
to his client. A counsel for the defence is allowed very 
considerable latitude in the cross-examination of the witness, 
and the latter should always be well prepared to meet the 
attack, with conscious strength, and calm and dignified com- 
posure. If, however, the advocate transcends, as he is some- 
times tempted to do, the bounds of propriety and decorum, 
the witness has always the right to appeal to the court for 
protection. It is far preferable to adopt the latter course, 
than to attempt to argue, or recriminate with counsel, since 
the latter has the witness always at disadvantage on the stand. 

The re- examination sometimes follows the cross-exam- 
ination of the witness, when it becomes necessary to clear 
up, or explain any matter that may have been obscured by 
the cross-examination. 



EXPERTS. 17 

After the examination of the State's witnesses, that of the 
witnesses for the defence follows. And here the same 
general line of examination is pursued as in the former 
case. When the medical witness for the defence is put upon 
the stand, a most unpleasant exhibition is, not unfrequently, 
made, of one expert directly contradicting another expert 
on the opposite side, and both of them medical men of 
equal standing and worth in the profession, and in the com- 
munity. Such professional tilting is sometimes sneeringly 
designated as the " war of the experts," and is certainly 
deeply to be regretted, as it tends greatly to prejudice 
both the court and the public against expert testimony in 
general; and this, of course, to the detriment of justice. 

It is proper to clearly understand the difference between 
an ordinary witness, and an expert witness. The former 
testifies only to facts which he has seen, or heard, or learned 
from personal observation. The " expert " or skilled witness 
{experins) does not necessarily testify to facts, but gives his 
opinion on facts observed by himself, or testified to by 
others. An expert witness is supposed to be specially skilled 
in the matter on which he is to testify. It is just here, we 
believe, that the real cause of difficulty lies in medico-legal 
cases involving expert evidence. The so-called "experts" 
are usually taken from the ranks of the medical profession. 
Such persons, because they are doctors, sometimes, unfortu- 
nately, imagine that they are therefore qualified to act as 
experts, without any previous medico-legal knowledge, or 
training. Of course, there must necessarily be a conflict of 
opinion where such an improvised witness is opposed to the 
genuine expert, on the witness stand. We believe that if 
all the experts were equally skilled, and equally qualified, 
and equally honest, there rarely could occur any conflict 
of opinions between the opposite sides, since both are 



18 MEDICAL JURISPRUDENCE. 

equally desirous of discovering and testifying to the truth, 
and truth is always undivided. 

No one should presume to assume the position of an 
expert witness who has not devoted his special attention 
to the matter under consideration, and who is, therefore, 
able really to enlighten the court and jury. 

The expert witness has his rights as well as his duties and 
responsibilities. One of these rights is his compensatioii. 
It has often been made a subject of just complaint that an 
expert witness is placed upon the stand, and his professional 
opinions, which may be of the utmost value in the pending 
case, extorted from him piecemeal, by the questionings of 
counsel, and yet he receives as his compensation merely the 
pittance of one dollar and a half a day — the pay of an ordinary 
witness! Some high legal authorities contend, very justly, 
that the expert is not bound to submit to this imposition, 
and that he is entitled to an adequate fee for his services, for 
which, however, he should arrange with the party calling him, 
before he gives his evidence. The English courts, we 
believe, have not yet definitely settled this matter. We are 
glad to see that a recent authority * uses the following 
pointed language concerning this matter : " No witness can 
be compelled to give his opinion in the witness box. 
Further, no one is bound to accept a subpoena merely to 
state opinions. The witness that can speak to any actual 
fact connected with the case must attend the trial, if required 
to do so, but the expert, however wide his experience, cannot 
be forced to give the court the value of his general or special 
knowledge." There can be no question as to the propriety 
and justice of this position ; but in this country, the practice 
of the courts in relation to the compensation of medical 
experts, is by no means settled. In the great majority of 

-^Tidy's Legal Medicine. Part I. Lond. 1882; p. 17. 



REMUNERATION TO EXPERTS. 19 

our States, the lazv allows no additional compensation to the 
expert; and it is not an unfrequent practice to subpoena him as 
an ordinary witness, and when in the witness box, to use him 
as an expert. What shall the expert do in such a case ? How 
shall he conduct himself consistently with his own dignity 
and proper rights? Certainly, the court would not use a 
man's private property — the work of his hands, his skilled 
manual labor, or the product of his farm or merchandise, 
without adequate compensation ; why, then, should they 
exact from him that which is the result of the labor of his 
brain, than which nothing can be more exclusively and 
definitely a man's own private property ? It is to be regretted 
that so few of our American courts and legislatures have 
appeared to recognize the true bearings of this subject, so that 
with us the old practice still prevails, of affording no legal 
protection to the medical expert, in the matter of fees.* 

In point of fact, however, it rarely happens, in important 
criminal cases, especially in poison cases, that either the 
prosecution or the defence would venture to trust their 
interests to a reluctant witness; and certainly he would be 
a reluctant witness who had been dragged, perhaps hundreds 
of miles from his home and business, by a subpoena, which 
the law forces him to obey, and who, after spending, it may 
be, days in attendance upon the court, is compelled to give, 
for the paltry pittance of the wages of a day-laborer, that 
which has caused him years of labor and study to acquire, 
in the shape of an opinion, on which may turn the question 
of life or death to the prisoner ! In all such cases, the 
ordinary practice is to arrange beforehand with the expert 
for his proper fee; and the witness should be admonished 
to look carefully about his interests in this matter. Let 

*As far as can be ascertained, only two of our States have legislated on 
this subject. 



20 MEDICAL JURISPRUDENCE. 

him remember that the district attorney, who usually directs 
the affair, has no authority to pay his fee ; neither does this 
authority lie with the court. The only responsible parties 
in the case are the county commissioners, or some other 
equivalent county authorities. With these alone ought the 
expert to make his arrangements, and always previously to 
undertaking the case; and to these alone can he look, 
legally, for his fee. 

As regards the obligation of a witness to obey a stibp(£na 
when he is to be questioned only as to his opinion, we think 
that, in this country, the mandate of the court is obligatory ; 
the witness's duty is to obey it, and then, if not previously, 
endeavor to arrange about his compensation, before giving 
his evidence. 

We venture a word of caution to the medical witness. 
Before undertaking any case, or consenting to act as an 
" expert " therein, be sure to institute a thorough examina- 
tion of all the bearings of the case, — its pros and cons. If 
retained by the defence, the expert has the right to examine 
the report of the State's expert; and this is of special im- 
portance in a poison case. A critical examination of this 
report will enable him to determine whether he can consci- 
entiously, and on scientific grounds, undertake to contradict 
and oppose the conclusions arrived at in this report. It is 
a most serious and responsible position for him to assume, 
and he ought to assume it only after a deliberate study of 
the case, and a strict consciousness of his ability to grasp 
it. If he finds nothing in the report that he cannot thor- 
oughly endorse, whether the results of chemical or other 
experiments, or whether the deductions from these experi- 
ments in the shape of opinions, our advice would be for him 
frankly to decline the case altogether. He should never go 
upon the witness stand as a mere partisan, nor offer his 



EXPERT TESTIMONY. 21 

professional shrewdness and tact, for pay, to the highest 
bidder ! If, however, a careful scrutiny of the report has 
satisfied him that the State has not made out its case (so 
far as the scientific evidence goes), but that serious blunders 
have been committed in the chemical and other experiments 
performed, whereby most erroneous conclusions have been 
reached, and which may vitally affect the result, then we 
are of the opinion that the expert not only need not 
hesitate to take the case, but that it is his bounden duty 
to do so, in order that he may aid in carrying out the ends 
of justice. 

This whole matter of expert testimony has long engaged 
the attention of some of the ablest minds in both the pro- 
fessions of law and medicine, but with no very definite 
results. No doubt, our present system of volunteer medical 
experts is open to serious objections, which, under our 
present laws, cannot be remedied. The only true and 
proper system, as it seems to us, is for each State to ap- 
point one or more experts, who shall be State officers, 
physicians of thorough education and experience, and train- 
ing in this particular line, who shall devote their time and 
attention exclusively to this duty, and for which they shall 
receive an adequate compensation. Such an office, properly 
filled, and kept aloof from all political considerations, would, 
we believe, be of real benefit to the State. It would, to a 
great extent, if not completely, abolish the unseemly con- 
tention of the experts in the court-room, inasmuch as the 
State expert (whose professional ability and moral standing 
should be absolutely unquestioned) would be present at 
every important trial, and give to the court and jury the 
results of his previous investigations in the case ; and, more- 
over, since he is to be presumed to be entirely impartial, 
without bias to either the prosecution or defence, his 



22 MEDICAL JURISPRUDENCE. 

Opinion would be generally received as final by both sides, 
and thus both contention and expense would be avoided. 

The above system of medical expert testimony re- 
sembles, in many respects, that of Germany, which we regard 
as superior to that of other countries. 

There are a few practical rules relating to the giving ot 
evidence, which it is well the medical expert should observe. 
The first of these is, that he should prepare himself thor- 
oughly upon all the points bearing on the case, in which he 
is called to give evidence. This he should do in order to 
further the ends of justice, and also to avoid personal 
censure. He should be accurate as to weights, measures, 
distances, size, relationship of objects, etc. 

Secondly. He should maintain a quiet, dignified and com- 
posed demeanor on the stand, not exhibiting any irritability 
of temper, however much he may feel provoked by the rude- 
ness of the opposing counsel. He should beware of any 
display of arrogance, or assumption of manner, or of stub- 
bornness, or testiness of behavior, which are sure to make 
him appear to disadvantage in the court room. 

Thirdly. The witness should give his answers in a clear 
and audible tone, addressing himself rather to the jury than 
to counsel, since the former are specially interested in his 
replies ; and these replies, together with his explanations, 
should always be given in the simplest possible language ; 
and they should be free from all ambiguity, otherwise they 
will require explanation, which is apt rather to weaken the 
testimony. 

Fourthly. He should never be afraid to say **I don't 
know," if he does not know. Nothing is more dangerous 
than for a witness to attempt to guess, for fear of being 
thought ignorant. 

Fifthly. He should particularly avoid the use of all 



DYING DECLARATIONS. 23 

technical expressions and learned formulae, in giving his 
description of the results of an autopsy, or of a toxicological 
examination, etc. For example, instead of saying that " the 
integuments of the cranium were reflected back, so as to 
expose the calvarium," he should simply announce that " the 
scalp was thrown back, and the skull, exposed;" and instead 
of telling the jury, in grandiloquent phraseology, that, in a 
case of assault and battery, he had found that the prosecutor 
** had received a severe contusion over the lower portion of 
the frontal bone, producing extensive ecchymosis around the 
eye, together with considerable infiltration of the subjacent 
areolar tissue," he should clear up the matter at once, by 
telling them, in plain English, that the man had gotten "a 
black eye" (Taylor). All such pomposity and pedantry will, 
of course, be avoided by every sensible and well-bred witness, 
since it is certain to expose him to well-merited ridicule and 
contempt. 

Dying Declarations. — By this term is understood such 
declarations as are made by a dying person, who, at the time, 
believed he was in actual danger of death, and that his 
recovery was impossible. Such declarations are received in 
evidence without being sworn to. The law presumes that 
all such declarations, made at so solemn a crisis as at a 
dying moment, must be sincere. They may not, however, 
necessarily be true, although sincere, i. e., believed in, at the 
time, by the deceased. Dr. Taylor quotes an instance of a 
dying woman in St. Thomas' Hospital, who accused a man 
of assaulting her. He was found guilty and executed. A 
year after the execution, the real murderers were discovered, 
and his innocence established. These declarations, more- 
over, must relate to the actual circumstances of the death, 
and to nothing else. 

/ 



24 MEDICAL JURISPRUDENCE. 

A magistrate, if he can be had, is the proper person to 
take down the dying man's declarations, the physician in 
attendance merely giving his opinion as to the hopelessness 
of the case, and the soundness of the man's mind. In the 
absence of the magistrate, the medical man is the best 
person to receive the dying declaration, or confession ; and 
he should content himself by simply writing down the exact 
words of the dying person, without any interpretation of 
them by himself He should then, if possible, make him 
sign the declaration, after first reading it over to him. 



MOLECULAR AND SOMATIC DEATH. 25 



CHAPTER 11. 

PHENOMENA AND SIGNS OF DEATH. 
SECTION I. 

MOLECULAR AND SOMATIC DEATH. — THE IMMEDIATE CAUSE OF 
DEATH, IN ALL CASES, TO BE FOUND IN EITHER THE HEART, 
LUNGS, OR BRAIN. — CHARACTERISTIC POST-MORTEM EVIDENCES OF 
THESE VARIETIES OF DEATH. — THE "SIGNS OF DEATH." — CESSA- 
TION OF THE CIRCULATION AND RESPIRATION. — CHANGES IN THE 
EYES. — PALLOR OF THE BODY. 

By molecular death is to be understood the incessant dis- 
integration of tissue which is going on in the body during 
the active processes of hfe ; the waste of material thus 
produced being compensated by the never-ending work of 
reparation. In youth, the supply is in excess of the waste, 
and growth is the result. In advanced age, the reverse is 
the case. Somatic death is the cessation of all the vital 
functions of the body, or the death of the whole body. The 
latter is the popular idea of death; and the time when it 
takes place is generally recognizable. The precise period 
when universal molecular death occurs cannot be accurately 
determined. No doubt, molecular life may continue some 
time after somatic death, as is evidenced by post-mortem 
caloricity {vid. post.) and by certain acts of nutrition and 
secretion, such as the growth of the hair and nails. 

Although the outlets of human life are so numerous and 
varied, and the phenomena attending the dissolution of the 
body are equally diversified, the immediate or actual cause 
of death, in every instance, must be referred to an arrest of 
the function of one, or other of the three great centres of life 
— the heart, the lungs, and the brain. And so intimately 



26 MEDICAL JURISPRUDENCE. 

are the functions of these three " centres " connected together, 
that when one ceases to act, the actions of the other two are 
speedily brought to a standstill. Each one of these three 
varieties has its own special phenomena or signs ; and each 
exhibits its own peculiar or characteristic post-mortem 
appearances. We adopt Bichat's classification of (i) death 
beginning at the brain, (2) death beginning at the heart, 
and (3) death beginning at the lungs. 

I. Death Begijining at the Brain — Coma. — Symptoms. — 
Stupor, more or less profound; insensibility to external im- 
pressions; loss of consciousness; breathing slow, stertorous, 
and irregular; respiration gradually ceases, as the medulla 
oblongata begins to be affected. The chest ceases to ex- 
pand; the blood is no longer aerated; the pulmonary circu- 
lation is arrested; the lungs cease to act, and finally the 
heart's pulsations are brought to a stop. 

Post-mortem, appearances. — i. Effusion of blood, or serum 
in the brain or cavities, caused by {a) apoplexy, (6) rupture 
of vessels, from injury or fracture of the skull. ,2. Embolism. 
3. Concussion from a blow or fall. 4. Abscess, tumor, or 
other organic disturbance. 5. Congestion of the vessels of 
the brain, caused by {a) disease, (B) narcotic poisons, {c) cer- 
tain mineral poisons, as barium and arsenic. 

II. Death Beginning at the Heart — Syncope. — ^The heart 
may cease to act, from two distinct causes: (i) from a 
deficiency in the quantity of blood, its normal stimulant 
(ancemia), and (2) from a defect in the quality of the blood, 
or from a loss of heart-power (asthenia). 

Ajtcemia is produced by sudden loss of blood, (i) disease, 
as in rupture of an aneurism ; (2) uterine and other hemor- 
rhage; (3) sudden discharges, etc.; (4) violence, as from 



DEATH FROM THE LUNGS. 27 

wounds of heart and large vessels, causing fatal hemor- 
rhage. 

Symptoms. — A mortal paleness of face ; lividity of lips ; 
vertigo ; cold sweat ; dimness of vision ; ringing in the ears ; 
slow, weak and fluttering pulse; gradual insensibility. There 
may also be nausea and vomiting, hallucinations, delirium, 
jactitations, irregular breathing, sighing, and convulsions 
before death. The nervous symptoms are due to want of 
brain power, in consequence of a deficient supply of blood. 

Post-mortem appearances. — Heart contracted and empty 
(if early inspected). If life has been protracted for several 
hours, a heart clot may be found. 

Asthejiia. — Here, the cause of the cessation of the heart's 
action is either a defect in the quality of the blood, or some 
disorder of the organ producing a loss of heart power: (i) 
by disease, as {ci) various cardiac disorders, such as fatty 
degeneration, etc ; ifi) all exhausting diseases, as phthisis, 
cholera, cancer, etc. ; (2) starvation; (3) certain injuries, as 
blows on epigastrium ; (4) certain poisons, as digitalis, 
prussic acid, and upas. 

Symptoms. — Coldness of hands and feet ; lividity of lips 
fingers, toes, nose and ears ; extreme muscular weakness; 
feeble pulse ; senses and intellect not affected, but preserved 
to the last. This latter is well seen in the collapse of Asiatic 
cholera. 

Post-mortem appearances. — The heart not contracted ; 
its cavities contain more or less blood, or else are dilated and 
flabby. 

III. Death from the Lungs — Apncea — {Asphyxia). — 
Respiration may be arrested (i) by any mechanical impedi- 
ment to the ingress of air (oxygen) into the lungs, as {a) 
pressure on the thorax ; (/?) tetanic spasm of the muscles of 



28 MEDICAL JURISPRUDENCE. 

respiration, as in tetanus and strychnia poison ; (<r) paralysis 
of the pneumogastric, or phrenic nerves ; (d) exhaustion of 
muscular power from debility, or cold ; {e) foreign bodies in 
the air passages ; (/") compression of the throat, as in hanging 
and strangling ; {g) suffocation ; {It) drowning. 2. By dis- 
ease, as pneumonia, phthisis, etc-., spasm of the glottis, 
oedema of the glottis, pharyngeal abscess, and embolism 
of the pulmonary artery. (Strictly speaking, most of these 
diseases cause death, through mechanical interference with 
breathing.) 

Symptoms. — Great dyspnoea, lividity of the face, loss of 
consciousness, vertigo, and convulsions. 

Post-mortem appearances, — The right side of the heart 
and the whole venous system are usually filled with dark 
blood; the left side, together with the arteries, is generally 
empty. Cases are however reported where the right cavities 
of the heart were found empty. The lungs themselves are 
nearly always gorged with dark blood ; but there are some 
exceptions to this, which will be noticed hereafter. 

By keeping in mind the foregoing varieties of somatic 
death, together with the characteristic post-mortem appear- 
ances attendant on each, the examiner will be considerably 
aided in arriving at a definite conclusion, as to the real cause 
of death, in any particular case. 

In every inquest over a dead body four important ques- 
tions will present themselves for solution: i. The reality 
of the death. 2. The cause of the death. 3. The time that 
has elapsed since the death. 4. In the case of the body of 
a new-born infant, — was it born alive? 

1. The first of these questions comprises the phenomena 
and signs of death. How can we distinguish a case of real 
from one of apparent death? In the great majority of 



SIGNS OF DKATH. 29 

instances, of course, there is no p'Vactical difficulty; but ex- 
ceptional cases do, at times, present themselves in persons 
recently dead, where the corpse still retains so much the 
appearance of life, as to occasion some doubts about the 
reality of dissolution. The natural horror of being buried 
alive also suggests the most scrupulous caution in the mat- 
ter, although we rarely, if ever, hear of cases of premature 
burial in civilized countries ; yet instances are not wanting 
to show that such may have actually occurred, in places 
where a fatal pestilence has prevailed to such a degree as 
to produce a panic, and demoralize the community. Dr. 
Tidy {Legal Med. p. 30) informs us that Professor Nussbaum, 
of Munich, states "that he believes many to have been buried 
during the war (Franco-German) that were not really dead, 
but merely suffering from an extreme lethargy arising from 
loss of blood, exhaustion, hunger, cold and fear" {your, de 
Med. de Bruxelles, February, 1871). 

The following may be regarded as the Signs of Death. 
We are, however, of the opinion that no single sign should 
be relied upon exclusively, but that several " signs " should 
always be present in determining the question. 

I. The complete and contiituous cessatioit of the functions 
of circulation and respiration. In some cases of apparent 
death these two functions seem to be suspended for a time, 
as in syncope, trance, catalepsy, etc.; but the suspension is 
not absolute, but only apparent. The absence of the pulse 
at the wrist is no criterion of the suspension of the circula- 
tion, as this may be going on so feebly, as only to be detected 
by a very close stethoscopic examination of the heart, which 
should never be omitted in cases of doubt. The condition 
of both the circulation and respiration, in such cases of 
apparent death simply resembles that of certain animals in 



30 MEDICAL JURISPRUDENCE. 

the state of hybernation. Thus, M. Bouchut informs us 
that in the marmot, while the heart-beats during its state of 
activity amount to 80 or 90 a minute, they are reduced 
down to 8 or 9 very feeble pulsations during the period of 
hybernation. Instances are recorded (like that of Colonel 
Townshend, by Dr. Cheyne) of a voluntary suspension of 
the heart's action ; but as these cases occurred many years 
ago, before the discovery of auscultation, it is, we think, 
highly probable that the suspension was not absolute, but 
only reduced down to so fine a point as to have escaped 
notice. It is certainly contrary to all scientific reasoning 
that life can continue many minutes without the circulation 
of the blood ; therefore we need have no hesitation as to 
the reality of death, if we can be positively certain of the 
coiitiniLous arrest of this function, say for one hour. The 
converse of this proposition, however, is not always true ; 
that is, the pulsation of the heart may continue for a brief 
space of time after actual death. Duval mentions having 
seen the heart of a criminal beat fifteen minutes after decapi- 
tation, the left auricle pulsating for an hour. This same 
phenomenon, as is well known, is witnessed still more 
remarkably in the heart of the turtle, and also of the shark, 
which will continue to pulsate many hours after removal 
from the body. 

This question of the beating of the heart in a still-born 
infant being regarded as a valid sign of life, will be dis- 
cussed hereafter, under the title of Live Birth. 

The same remarks may be made with regard to the func- 
tion of respiration. The absolute and continuous cessation 
of breathing — 'Say for one hour — maybe regarded as a posi- 
tive sign of death. In cases of apparent death, as already 
remarked, this function may apparently be suspended ; but 
it is in reality only reduced down to its minimum of action. 



CONDITION OF THE EYES. 31 

This likewise should be verified by careful and repeated 
auscultation. The common practice of holding a feather 
near the nose or mouth may serve, by its movements, to 
indicate breathing. So likewise the deposit of moisture on 
a mirror, held in the same position, will indicate the feeblest 
respiration. But neither of these is an absolutely positive 
sign, since they both fail when applied in the case of the 
hybernating animal, which we know is really alive. 

Another method is to place a small vessel containing 
mercury on the thorax of the body lying on its back; the 
slightest respiratory action will be indicated by the move- 
ments of a reflected image, made to fall on the surface of the 
bright metal. 

It may be remarked that in cases of trance, catalepsy, 
and other instances of suspended animation, the body never 
exhibits either the pallor, or coldness of real death. More- 
over, if a ligature be applied around the finger of a corpse, 
no change of color will be observed; but if the experiment 
be made on a living body, the tip of the finger will become 
of a deep red or purple color, in consequence of the arrest 
of the capillary circulation at that spot. 

II. The Condition of the Eyes. — The changes produced in 
the eyes by death consist (i) in the entire loss of sensibility 
to light : the pupils neither contract nor expand under this 
stimulus. This, however, cannot be regarded as a positive 
sign, since the same insensibility to light is witnessed in 
certain cerebral affections during life ; it is also the result of 
the action of certain poisons. (2) The action of atropia 
and other mydriatics to expand the pupil, and of calabar 
bean to contract it during life, is lost within a few hours 
after death. These agents do, however, produce a visible 
effect if applied very soon after the cessation of life, and 



32 MEDICAL JURISPRUDENCE. 

before the body has become cold, and all muscular irrita- 
bility has ceased. (3) The cornea loses its transparency, 
and the eyeball its elasticity, very speedily after dissolution. 
But these conditions may likewise exist before death, as 
the effects of disease. In apparent death, the cornea retains 
its translucency ; the papilla of the retina is of a rose-red 
color ; and the fundus of the eye is furrowed by the arteries 
and veins of the retina. At the moment of death, the 
papilla of the optic nerve becomes quite pale, and the cen- 
tral artery of the retina disappears (M. Bouchut, La Tribune 
Medicale, No. 47, i ^6^). It should also be remarked that the 
eye sometimes retains its lustre after death, as is witnessed 
after poisoning by prussic acid and carbon dioxide. 

III. The Ashy Pallor of the Body. — This sign is very uni- 
form, though not without some exceptions, as in the case 
of persons of very florid complexions, and in exceptional 
instances where the cheeks retain their pink color for some 
days after death, so as to occasion some uncertainty as to 
the actual fact of death in the minds of relatives. It is also 
wanting in cases of death from yellow fever and jaundice; 
moreover, the red, inflammatory zones around ulcers, tattoo 
marks, the spots of purpura, and ecchymoses or bruises, do 
not disappear after death. It must also not be forgotten 
that a death-like pallor is seen in cases of swooning, and 
sometimes in the cold stage of ague and in collapse. 

SECTION II. 
SIGNS OF DEATH CONTINUED. — LOSS OF ANIMAL HEAT. — POST- 
MORTEM CALORICITY. — RIGOR MORTIS. — POST-MORTEM LIVIDITY, 
OR SUGGILLATION. 

IV. Loss of Animal Heat. — During life the animal body 
possesses the wonderful faculty of maintaining its own 
normal temperature (about 98° F.) independently of the 



LOSS OF ANIMAL HEAT. 33 

surrounding medium. This is effected as the result of 
certain vital processes. When these cease at the moment of 
dissolution, the temperature of the body immediately begins 
to decline, and it continues so to do progressively until it 
attains that of the surrounding medium. It never gets 
lower than the latter, unless the temperature of this medium 
becomes suddenly increased ; then, for a while, the body will 
be really colder than the temperature of the atmosphere. 
The sense of touch does not convey an accurate idea of 
the actual coldness of the dead body, since the conducting 
power of the tissues varies materially. The direct appli- 
cation of the thermometer to the body is the only safe 
criterion. 

The time when the cooling of the body is completed may 
be stated to be, on the average, fifteen to twenty-four hours. 
Prof Casper makes it from eight to twelve hours. But it 
varies very considerably, according to the condition of the 
body itself, according to the medium in which it is kept 
after death, and also according to the manner of death. 
Thus, fat bodies retain heat longer than lean ones ; the 
bodies of young children and of old persons cool more 
rapidly than those of adults ; whilst the bodies of those who 
die from lightning, or suffocation are said to retain heat 
longer than others. 

The body cools more rapidly if exposed to the air, 
unclothed, than if covered up iir the bed clothes ; also in a 
large, airy apartment, than in a small, close room. It will 
cool more rapidly in water than in the air. In death from 
chronic wasting diseases, and also in cholera, the body cools 
very rapidly. According to Dr. Taylor, loss of blood does 
not hasten the cooling process. 

The interior of the body retains its heat considerably 
longer than the surface, so that if an autopsy be made 
3 



34 MEDICAL JURISPRUDENCE. 

twenty-four hours after death, or when its exterior feels per- 
fectly cold, the abdominal viscera may exhibit a temperature 
twenty degrees, or more, higher than that of the surface. 

It should not be forgotten that coldness of the body is a 
frequent phenomenon of sickness ; it is witnessed in hysteria 
and ague, also in cholera. Its value as a sign of death con- 
sists in the fact that it is progressive, and continuous, whilst 
the coldness of disease is sudden, and not permanent. 
Hence, the degree of coldness of the body will often be a 
good indication of the time that has elapsed since death. 

The singular phenomenon is sometimes exhibited of a 
rise of temperature after death, instead of a fall. This excep- 
tional condition occurs in the bodies of persons who have 
died from yellow fever, cholera, tetanus, smallpox, and some 
other acute disorders. The precise cause of this singular rise 
of temperature (^post-mortem caloricity) is not clearly under- 
stood. In some instances the increase of heat amounted to 
nine degrees F. Dr. Davy records a post-mortem tem- 
perature of 113° F. in the pericardium. We must suppose 
in these cases that, after general or somatic death, there still 
lingers some remnant of vitality in the tissues, or rather 
that molecular life has continued after the cessation of 
somatic life. We know that muscular irritability and con- 
tractility continue for many hours (under certain conditions) 
after death, and this undoubtedly indicates the continuance 
of their molecular activity, up to a certain point. 

Another fact to be here noticed is that the rate of cooling 
after death, although progressive, is not uniform ; it is 
much more rapid during the earlier hours, than later. Dr. 
Goodhart's observations show that during the first three 
hours after death the loss of heat, per hour, amounted, in 
the robust, to 3.5°, in the emaciated, to 4.7° ; whilst, when 
the body was nearly cold, the loss, per hour, was, in the 



CADAVERIC RIGIDITY. 35 

emaciated, 1.12° and in the robust, 1.26° (Tidy's Leg. Med., 
P- 49)- 

V. Cadaveric Rigidity, or Rigor Mortis. — By this is under- 
stood the stiffening of the body, so generally observed after 
death. It usually occurs simultaneously with the cooling 
process. It may be stated to be universal in death from 
any cause, and to be present in the lower animals, as well as 
in man. In some instances, however, it is so transient as 
to escape notice. It comes on at very variable periods, 
from a few moments, to eighteen to twenty hours after 
death. This remarkable variation in its approach is chiefly 
due to the condition of the muscular system at the time of 
death. Its duration is equally variable, lasting from a few 
moments, to many hours, or even weeks. After the rigidity 
passes off, the body regains its original pliancy, and decom- 
position immediately commences. As a general rule, the 
putrefaction of the body is retarded until the rigor mortis 
has passed off. 

It commences usually in the muscles of the eye, which 
often become rigid within a few minutes after death; next 
in the muscles of the neck and lower jaw; then in the chest 
and upper extremities ; afterwards in the muscles of the 
abdomen and lower limbs. The rigidity generally passes 
off in the same order; thus the legs frequently remain quite 
rigid, after the upper portion of the body has regained its 
suppleness. 

The seat of the rigor mortis is undoubtedly the muscular 
system. That it is in no wise dependent upon the nervous 
system, is proven by the fact that all the nerves supplying a 
muscle may be divided, and yet the muscle will continue to 
act, contracting under the galvanic stimulus. But it ceases 
immediately on division of the muscle. Even the removal of 



36 MEDICAL JURISPRUDENCE. 

the brain and spiral marrow has no effect in preventing the 
muscular contraction. Again, the muscles of a paralyzed 
limb become equally rigid with those in sound health. The 
cause of the contraction is usually ascribed to the coagulation 
of the muscular plasma (myosin), an albuminous principle 
possessing the property of coagulation to a high degree. 
The chemical action of a muscle in rigor mortis is acid 
(reddens blue litmus), but it becomes alkaline after the 
rigidity passes off. While in the state of rigor mortis, the 
muscle is opaque; before this, it is partially translucent. 
Brown-Sequard has shown that a current of arterial blood 
will restore muscular contractility to a rigid limb. 

The duration of rigor mortis is one of its most important 
features. As already observed, this is extremely variable, 
although, as a rule, it does not set in until the body has 
begun to cool ; still, in some of the lower animals, and 
notably in birds, it often manifests itself while the body is 
still warm. From the observations of Brown-Sequard and 
others, it appears that the period after death when the rigor 
mortis manifests itself, together with its duration, is de- 
pendent chiefly, if not altogether, upon the previous degree 
of muscular exhaustion. To properly understand this, it 
should be remembered that immediately after death the 
muscles are in a state of complete relaxation, giving to the 
body perfect pliancy. This condition may last for so brief 
a space of time as not to be noticed, though usually it 
continues for three or four hours, when rigidity commences. 
During this period of relaxation, the muscles have not yet 
lost their molecular life, so that they will respond to galvanic 
and other stimuli. Hence, although the contraction of a 
muscle by electricity is no positive sign of somatic life, still 
it will enable us to conclude either that the person is yet 
alive, or more probably, that death has very recently 



CADAVERIC RIGIDITY. 37 

occurred. The cessation of all muscular contractility under 
galvanic stimulus is a proof, not only of the death of the indi- 
vidual, but it also indicates that the death was not very recent 
— hardly within three, or four hours. So long as the muscles 
retain their contractility, the rigor mortis is postponed. 

It can now be understood that whatever produces ex- 
haustion of the muscular system, must thereby hasten the 
approach of cadaveric rigidity. Thus, in death from ex- 
hausting diseases, as in phthisis or after protracted con- 
vulsions, or when the muscular system becomes exhausted 
by over-exertion and fatigue, as is seen in over-driven 
cattle, or animals hunted in the chase, the rigor mortis 
shows itself early, and lasts but a short time ; whereas, if 
death occurs suddenly, in a previously healthy person, the 
rigidity is postponed for many hours, but when once estab- 
lished, it continues for a much longer period. Thus, 
according to Brown-Sequard, the bodies of decapitated 
healthy criminals were observed not to become rigid until 
after the lapse of ten to twelve hours, and the rigidity 
lasted over a week, even in warm weather. An experiment 
of the above named physiologist very satisfactorily proves 
this statement. Three dogs of equal size were poisoned 
with strychnia in different doses. One took two grains, 
and died almost immediately. The second took half a grain, 
and died in twelve minutes. The third took one-fourth of 
a grain, and died, after protracted convulsions, in twenty-one 
minutes. In the first animal, whose muscular system had 
been least exhausted by the spasms, rigor mortis did not 
set in before the lapse of eight hours, and the duration was 
nineteen to twenty days. In the second, where the muscular 
exhaustion was greater, the rigidity appeared after two and 
a half hours ; and lasted five days. In the third, in which 
the muscular exhaustion was the most protracted, the rigor 



38 MEDICAL JURISPRUDENCE. 

mortis was developed as early as thirty minutes, and lasted 
less than a day. 

It has been supposed by some, that the rigor mortis does 
not occur in the bodies of persons killed by lightning; this, 
however, is a mistake, as experience abundantly proves. 
Neither is it interfered with by the previous loss of blood 
by hemorrhage. It is, however, dependent on temperature, 
at least, so far as regards the duration, which is shortened 
by heat and prolonged by cold. Bodies submerged in cold 
water retain their rigidity for a considerable length of time. 

When a joint or articulation stiffened by rigor mortis (if 
this be complete), is forcibly bent, the rigidity is destroyed. 
If, however, the rigidity is incomplete, it will be resumed 
afterwards. This may serve to distinguish real death from 
certain cases of catalepsy, tetanus, and hysteria, accompanied 
by rigidity. In all these latter cases, the stiffness will return, 
on removal of the opposing force. 

Cadaveric rigidity is not so strong as voluntary muscular 
contraction. As a rule, the flexors are more affected than 
the extensors, so that the limbs are generally found to be 
slightly bent after death. 

The fact that the involuntary muscles are likewise subject 
to rigor mortis should not be lost sight of, as it might lead 
to an error as to the true pathological state of an organ on 
making an autopsy. The heart, for instance, may be found 
very firmly contracted after death by rigor mortis ; this 
might be mistaken by the inexperienced, for a true contrac- 
tion of the organ, the result of previous disease. 

Closely connected with rigor mortis, if not indeed a modi- 
fication of this very state, is the condition described as 
cadaveric spasm. This is exhibited in the bodies of persons 
who have died by sudden and violent deaths, in whom there 
seems to be present a strong will-power just prior to the 



CADAVERIC LIVIDITY. 39 

death, and producing strong muscular contraction at the 
moment of dissolution. This spasmodic contraction, more- 
over, appears to pass at once, after death, into the usual 
rigor mortis. The best illustrations of this peculiar condi- 
tion are afforded in those cases of determined suicides, who 
have taken their lives by shooting themselves with a pistol. 
Very commonly in such cases, the lethal weapon is found 
so tightly grasped in the dead man's hand, as to require 
considerable force to remove it. The same thing is some- 
times witnessed in the bodies of drowned persons ; fragments 
of wood, grass and weeds, or other objects which had been 
convulsively seized in the water before death, being found 
tightly grasped in the hands ; and where two persons have 
perished together by drowning, it is not uncommon to find 
them, after death, convulsively clasped in each other's arms. 
To a similar reason, doubtless, is to be ascribed the singular 
and striking posture which the bodies of soldiers, on a field 
of battle, killed in conflict, are noticed to have assumed in 
the act of dying. Thus, the attitude of one is described as 
" resting on one knee, with the arms extended, in the act of 
taking aim ; the brow compressed, the lips clenched — the 
very expression of firing at an enemy stamped upon his 
face, and fixed there by death. A ball had struck this man 
in the neck. Another was lying on his back, with the same 
expression, with his arms raised in a similar attitude, the 
minnie musket still grasped in his hands undischarged " 
(Taylor). 

VI. Cadaveric Lividity, or Suggillation. — This term is 
applied to those livid, or violet-colored patches, or discolor- 
ations, which are observed upon the body at variable periods 
after death, usually after several hours. It is the result of 
the settling of the blood in the capillaries by gravitation. 



40 MEDICAL JURISPRUDENCE. 

Hence it is noticed in the most dependent parts of the body, 
such as (supposing it to be lying on the back) the back, 
sides, and under surface of the neck, calves of the leg, and 
under portions of the thighs. These patches, at first isolated, 
gradually increase in size, and coalesce, so as to cover a larger 
surface of the body. Cadaveric lividity is an unquestionable 
"sign" of death. It makes its appearance sometimes much 
earlier than at others ; and for this variation no very satis- 
factory reason can be assigned. 

The most important point connected with cadaveric 
lividity is not to confound it with ecchymosis, or bruising, 
to which it bears a considerable resemblance. Several cases 
are recorded where a body has been found covered with 
these death spots, and the mistake has been made of sup- 
posing them to be bruises, and consequently attributing the 
death to violence inflicted during life. The medical exami- 
ner should be particularly cautious not to confound them. 
Fortunately, a very simple test will settle the question. If 
the scalpel be drawn through a suggillation, no blood will 
flow ; the most that will be observed will be a few bloody 
points or specks, arising from the division of small veins of 
the skin. If, however, the patch be ecchymosis (where the 
effused blood has been infiltrated into the cellular tissue), 
the incision will either be followed by a flow of blood, or else 
a coagulum will be seen. Moreover, whilst the ecchymosis 
is sometimes raised above the level of the surrounding skin, 
the cadaveric stain never is. These spots are not affected 
by age, sex, or constitution ; and they follow upon all kinds 
of death, not excepting that caused by hemorrhage. 

Suggillation takes place in the internal organs as well as 
upon the surface of the body, producing in the former, 
appearances strongly resembling true congestion and in- 
flammation, for which they are without doubt frequently 



PUTREFACTION. 41 

mistaken by the inexperienced ; and as it may be a matter 
of considerable consequence, in a post-mortem examination, 
not to confound these two conditions, the examiner should 
be very cautious as to his pathological inferences These 
internal suggillations are also termed hypostatic congestions ; 
they appear chiefly in the lungs, brain, kidneys and intestines. 
The fact that they invariably occur in the most dependent 
portions of these organs should be suggestive of their true 
origin, since a real congestion or inflammation exhibits 
itself either throughout the whole organ, or else upon its 
upper surface equally with the lower one. Certainly, it is 
not confined exclusively to the under portion, as is the 
suggillation. When it occurs in the intestines, it may readily 
be distinguished from true inflammation, by simply lifting up 
several folds of the bowels, when the horizontal line, which 
previously had marked the hypostatic settling of the blood, 
becomes immediately broken and disjointed, whereas, if it had 
been a real congestion or inflammation, the redness would 
have involved the whole circumference of the intestines, 
and there would have been no broken line of separation. 

In the brain, hypostatic congestion might be mistaken, by 
the inexperienced, for one form of apoplexy ; and in the spinal 
cord it might be confounded with spinal meningitis. In the 
heart, true suggillation is not believed to occur ; but this 
is replaced by the formation of post-mortem clots, called 
polypi of the heart. 

SECTION III. 

SIGNS OF DEATH CONTINUED. — PUTREFACTION — EXTERNAL AND IN- 
TERNAL SIGNS. — ADIPOCERE. — MUxMMIFICATION. — HOW LONG SINCE 
THE DEATH ? 

VII. Putrefaction. — This is usually regarded as the most 
unequivocal " sign " of death. By this term is understood 
those spontaneous chemical changes undergone by all dead 
3* 



42 MEDICAL JURISPRUDENCE. 

animal bodies, resulting in the elimination of fetid gases. 
The period after death when putrefaction first manifests 
itself varies considerably, being dependent upon several 
conditions, some of which are connected with the body 
itself, and others extraneous to the body. 

Among the conditions inherent to the body itself are : 
I. Corpulence. Fat and flabby bodies undergo putrefaction 
more speedily than thin and lean ones, doubtless on account 
of the preponderance of fluids in the former. 2. Age and 
Sex. For the same reason the bodies of new-born children, 
and of women dying in child-bed (according to Casper), 
decompose more rapidly than others, especially the aged. 
3. TJie manner of death. The bodies of persons dying after 
an exhausting disease, especially if the vitality of the blood 
has been impaired, as in typhus fever, undergo rapid putre- 
faction ; also after death from certain poisons, and especially 
poisonous gases, as coal gas and sulphuretted hydrogen ; 
also from suffocation from smoke, and, indeed, from suffoca- 
tion generally. Putrefaction is also accelerated in bodies 
that have been much bruised and mangled by machinery, 
or railway and other accidents ; but we must except those 
cases where the body remains protected from atmos- 
pheric influences, as when buried beneath ruins, etc. On 
the other hand, the process is retarded in death by alcohol, 
phosphorus, sulphuric acid, arsenic, and some narcotic 
poisons. The antiseptic properties of alcohol and arsenic 
are well understood. The action of sulphuric, and doubt- 
less the other mineral acids, is probably to neutralize the 
ammonia as fast as it is formed, rather than actually to 
retard the process of putrefaction. Admitting all the above 
conditions, and giving them due allowance, there are doubt- 
less other causes, as yet unknown to us, which influence the 
rapidity of putrefaction. Casper adduces the instances of 



PUTREFACTION. 43 

four men, all of about the same age and general physique, 
and all suddenly killed in a riot. They were all buried 
at the same time, and in precisely similar coffins and 
graves ; yet, on subsequent examination, the progress of 
decomposition in the several bodies was found to vary very 
considerably. 

The external or objective conditions influencing putre- 
faction are air, moisture and temperature. The influence of 
the atmosphere upon animal decomposition is well under- 
stood, and is familiarly witnessed in the preservation of 
meats and other articles of food in hermetically sealed cans, 
for an indefinite length of time. It is undoubtedly the oxy- 
gen of the atmosphere that is the destructive agent, since 
flesh may be preserved in nitrogen (the other constituent 
of air) for a long period. Moreover, the oxygen must 
be in a free state, as it exists in the atmosphere, and not in 
a compound, as in carbonic acid gas, or nitrous and nitric 
oxide. These gases do not act as decomposing agents. 
The influence of atmospheric air is not limited to the mere 
supply of oxygen, but it modifies putrefaction according to 
the amount of moisture it contains. For this reason, per- 
fectly dry air, such as that of the arid deserts of Arabia and 
Africa, by its rapid desiccating properties, arrests putrefaction; 
the body speedily losing its fluids by evaporation, dries, and 
shrivels up into a sort of mummy. The effects of an entire 
exclusion of air in retarding the process of decomposition 
in a human body are witnessed in the burial of royal per- 
sonages in leaden coffins hermetically sealed, and these 
afterwards enclosed in marble sarcophagi. When these 
have been opened, hundreds of years subsequently, the 
remains have been found in a remarkable state of preserva- 
tion. On the other hand, bodies naked, or but slightly 
clothed, and buried in pine coffins, which soon decay, and 



44 MEDICAL JURISPRUDENCE. 

in shallow graves, to which the air has easy access, will 
undergo very speedy decomposition. The nature of the 
soil, and the depth of the grave also materially influence this 
process. Thus, a loose, sandy soil and a shallow grave favor 
it, by the ready admission of air, whilst one of a stiff, clayey 
nature, and a deep grave would retard it, for the opposite 
reason. From recent observations, it is highly probable 
that the real cause of atmospheric influence upon decompo- 
sition is the presence of the bacteria or baccilli which float 
in such myriads in the air, and which find their peculiar 
habitat in dead animal matter. 

The effect of moisture as an agent in animal putrefaction 
is to aid it, by favoring solution. The different tissues and 
organs of the body undergo decomposition just in propor- 
tion to the amount of fluids they contain. In this respect 
the brain of the young infant, and the eye contrast widely 
with the bones and teeth. The human body contains eight- 
tenths of its whole weight in fluids; hence its great tendency 
to putrefy after death. The bodies of drowned persons 
undergo rapid decomposition, unless the water be extremely 
cold. In the latter case, the low temperature acts as a 
preservative. Likewise, bodies thrown into dungheaps and 
cesspools speedily putrefy, from a similar cause, although 
the process may also be aided by the warmth of these media. 
If a body be completely deprived of its fluids by drying, 
putrefaction is arrested, as was remarked under the preceding 
head. 

The influence of temperature as an agent in putrefaction 
is very manifest. The temperature most favorable to this 
process is that between 70° and 100° F. It commences, 
however, as low as 50°, but it is completely arrested at 32°, 
below which the body becomes frozen, and also at 212°, 
when it becomes desiccated by complete loss of its fluids, 



PUTREFACTION. 45 

through evaporation. As is well known, an animal body 
may be preserved for an indefinite period if completely frozen 
in snow or ice. It is recorded that the body of a Russian 
nobleman that had been buried in the frozen soil of Siberia, on 
being exhumed, after a period of ninety-two years, was found 
in a state of almost perfect preservation. On the other hand, 
the effects of a high temperature as a preservative are wit- 
nessed in the mummies of Egypt and adjacent countries. 
In this case, however, the dryness of the atmosphere as well 
as the high temperature assists in the preservation. 

The effect of temperature in the process of putrefaction is 
familiarly shown in the influence of the seasons. Thus, in 
summer a body will decompose very much sooner than in 
winter — a circumstance that should not be forgotten when 
giving an opinion respecting the date of death in an unknown 
case. According to Casper, the relative rapidity of decom- 
position in bodies exposed to the air, kept in cold water, and 
buried in the earth, is in the ratio of one, two and eight ; that 
is, putrefaction advances as rapidly in one week in the open 
air, as in two weeks in the water, and in eight weeks in the 
earth (average). It may here be remarked that a body 
floating near the top of the water will decompose more 
rapidly than when at the bottom ; and when taken out of 
the water and exposed to the air, the putrefaction will be 
far more rapid than if left in the water. 

External signs of Putrefaction. — The following is the 
order generally observed, externally, in the progress of 
putrefaction of bodies exposed to the open air. In one to 
three days in summer (three to six in winter), there first 
appears a greenish, or yellowish-green spot upon the 
abdomen, three or four inches in diameter, accompanied 
with the peculiar odor of putrefaction. The eyeball becomes 
soft and yielding within the same period. In a few days 



46 MEDICAL JURISPRUDENCE. 

more, this greenish discoloration has spread generally over 
the whole body, first in spots, which subsequently gradually 
coalesce. Dirty red streaks now show themselves 
throughout the surface, marking the course of the blood 
vessels. In ten or fifteen days (in warm weather), the 
epidermis begins to loosen, forming blebs or blisters con- 
taining fluid. Gases now begin to form in the chest and 
abdomen, causing these cavities to swell out greatly. The 
eyeballs protrude, from the same cause ; the face is swollen ; 
the features so much bloated as no longer to be recog- 
nizable. In two or three weeks, the blebs of the cuticle 
may have burst open ; maggots appear ; the formation of 
gases increases, so that the body is enormously swollen. If 
it be now punctured, the gas which is emitted will frequently 
take fire on the approach of a flame (carburetted hydrogen). 
Other gases are likewise formed, the result of animal 
decomposition, as carbonic acid, sulphuretted hydrogen, 
phosphoretted hydrogen, nitrogen, and ammonia. The 
nails now loosen ; and in the further progress of putrefac- 
tion the cavities burst open, and discharge their contents ; 
the softened flesh dissolves off from the bones, which now 
become exposed, and ultimately fall apart from the skeleton. 
The sexes cease to be distinguishable, except perhaps by 
the discovery of a uterus, which appears to be the very last 
organ to yield to putrefaction. 

The above description is only a very general and average 
one, since the process of the external putrefaction of the 
body is so very variable, and is influenced by so many 
circumstances, all of which are not yet fully understood. 

Internal signs of Putrefaction. — The order in which the 
internal organs of the body undergo decomposition, being 
more regular as to time, affords a rather better criterion as 
to the time of death. The first organ of the body that 



ORDER OF PUTREFACTION. 47 

shows signs of decomposition after death is the Hning 
membrane of the windpipe (larynx and trachea) ; this 
assumes a dirty red coloration simultaneously with the 
appearance of the greenish spot upon the abdomen. That 
this is not the result of injection of the blood vessels is 
proven by the microscope. In the earliest stage of death, 
this membrane is always very pale, except when the death 
has been caused by laryngitis, or suffocation. The ex- 
aminer should be cautioned not to mistake this mark of 
putrefaction for congestion. Very soon after this stage of 
redness, it becomes of an olive-green color, and the rings 
of the trachea separate, and it all falls to pieces and dis- 
appears. 

The next (2) organ to decompose is the brain of young 
infants. The reason of this lies, of course, in the fact that 
this organ at such an early age is so very delicate, and is 
so little protected, by its bony covering, from the outer air. 
When decomposing, it changes into a soft, rosy, pulpaceous 
mass, and flows away out of the smallest openings. 

Then follows (3) the stomach. This organ is among the 
earliest to putrefy after death. The decomposition first 
manifests itself in discolorations of the fundus, together 
with the formation of dirty red spots in the posterior 
portion of the fundus, owing to hypostatic congestion. 
These spots soon ramify, and cover the whole lining mem- 
brane. There is great risk of mistaking these spots for 
signs of congestion or inflammation due to irritant poison- 
ing. The examiner should be specially cautioned on this 
point, as it is often impossible to distinguish them apart by 
a merely ocular inspection. It is quite certain that a post- 
mortem redness of the mucous membrane of the stomach 
cannot of itself prove a case of poisoning. In the further 
progress of putrefaction, the stomach softens, the spots 



48 MEDICAL JURISPRUDENCE. 

become greenish and gray ; then black, with dark red 
streaks (veins) running through them. It is finally con- 
verted into a pulpaceous mass, and ceases to be recognized. 

Next to the stomach, the intestines (4) follow in the pro- 
cess of decomposition. They become discolored very much 
as in the case of the stomach ; then they burst open, and 
discharge their contents, forming a greasy mass which finally 
disappears. 

The spleen (5) comes next in the order of putrefaction. 
If not diseased at the time of death, it may retain its integ- 
rity for two or three weeks. It first assumes a dark red 
color, then a greenish-blue, then becomes soft and pulpy, so 
that its substance can be rubbed down with the handle of 
the scalpel. 

Following the spleen, the ojuentnm and mesentery (6) are 
the organs next to decay. If there is not much fat con- 
nected with them, they will rapidly dry up, and disappear. 

The/Zz^^r (7) resists putrefaction for a.considerable time after 
death — in adults for several weeks. In infants it decomposes 
earlier. It first becomes of a green color, then black ; then 
softens, shrivels, and finally disappears. In case of death by 
arsenic poisoning, the liver would be likely to resist decom- 
position for a very considerable time, in consequence of the 
affinity of that organ for arsenic, which would exercise its 
preservative influence over it. 

The brai7i of adults (8) does not begin to show signs of 
putrefaction until the end of the fourth or fifth week, and 
sometimes even later. The process commences at the base, 
which softens and becomes bluish-green, and gradually 
progresses upward, and then inward. If the ^^rain has 
been injured, as by a depressed bone, or by a gunshot 
wound, it is affected earlier. 

Next in order is the licart (9). This is one of the toughest 



ORDER OF PUTREFACTION. 49 

of all the organs. The softening here begins in the columnae 
carneae, and progresses outward toward the walls of the 
organ, which finally deliquesce into an unrecognizable 
mass. 

It is remarkable that the limgs (lo), which are very soft 
organs, and are so nearly connected with the outward air, 
should resist putrefaction so long. These organs are often 
found quite sound for weeks after death, provided they were 
healthy and uninjured at dissolution. The first evidence of 
their decomposition is the formation of little bladders of air 
in the sulci, between the lobes, on the under surface, looking 
hke a string of beads. These increase rapidly, the lung 
structure turning first green, then black, and finally softening 
and disappearing. 

The kidneys (i i) follow the lungs. They become reddish- 
brown, and soften ; then they assume a greenish-black color, 
and soften and disappear. Next in order (12) follow the 
urinary bladder and (esophagus. Next (13) the pancreas, 
which, though a soft organ, and located near the stomach, 
is among the last to decompose. Then follow (14) the 
diaphragm and the arteries ; the tissue of the latter resisting 
putrefaction while everything else around them has fallen 
into a shapeless mass. 

Last of all, according to Casper, is the uterus (15), which 
has been found to retain its identity at the end of seven 
months after death. This fact is of great medico-legal 
importance, where the question arises of the possibility of 
pregnancy. 

The above description of the progress of putrefaction, both 
external and internal, of the human body is taken chiefly 
from Prof Casper's work on Forensic Medicine, translated 
and published by the Sydenham Society. It is intended to 
represent the average, both as regards appearance and time. 



60 MEDICAL JURISPRUDENCE. 

As already stated, there may be considerable deviations from 
the order laid down, depending upon a variety of circum- 
stances. 

Saponification, or Adipocere. — It sometimes happens, in 
the course of the putrefaction of the body, that this process 
is interfered with under peculiar circumstances, and gives 
place to a new condition, known as the saponification of the 
body, or the production of adipocere. This remarkable 
condition was first observed by Fouroroy, who discovered, 
during the removal of human remains from one of the 
public cemeteries of Paris, that a number of the bodies, 
instead of undergoing ordinary putrefaction, had been con- 
verted into a new substance, which he styled adipocere, 
from its resemblance to a combination of fat (adeps) and 
wax (cera). 

This adipocere has an unctuous feel, somewhat like 
spermaceti, and is of a whitish, discolored appearance. By 
the analysis of M. Chevreul, it was found to be an ammo- 
niacal soap — a compound of stearic and oleic acids, united 
with ammonium. In the course of putrefaction, the fatty 
acids of the body combine with the ammonia, which is the 
result of the decomposition of the nitrogenized tissues. It 
is interesting to inquire what are the conditions under which 
this singular process of saponification replaces the ordinary 
decomposition of the body. The presence of water is essen- 
tial to it It only occurs in bodies that have been buried in 
wet, or very moist soil. It never happens to those interred 
in a loose, or sandy soil. It is frequently the case that when 
the grave, after burial, fills with water, the contained body 
is converted into adipocere. The same thing takes place in 
bodies which remain in the water for a certain length of 
time. 



ADIPOCERE. 



51 



The composition of adipocere is not always precisely the 
same. Its base may consist of either ammonia or lime. 
The latter takes the place of the former, whenever the sapo- 
nified substance remains for any considerable time in water 
containing any salt of lime. This was determined experi- 
mently by Orfila, who placed an ammonium adipocere in a 
solution of sulphate of lime; he found that after a time it 
had been changed into the oleo-stearate of lime. Adipocere 
is insoluble in water, but partially soluble in alcohol. It 
takes fire and burns at a temperature of about 212° K., 
emitting a greasy smell. It contains a coloring matter, and 
an odorous and a bitter principle. Its odor resembles some- 
what that of musty cheese. 

From the fact that if a body remain immersed in the 
water for any length of time it is likely to be changed into 
adipocere, it becomes an important medico-legal question 
to establish the period necessary for this conversion. De- 
vergie ascertained that the body of a new-born child was 
more or less changed into adipocere after remaining in the 
water for five or six weeks. We see at once the value of 
this knowledge to the legal physician, since the bodies of new- 
born infants are frequently thrown into wells, privies and 
cesspools, by their unnatural mothers. If such a body be 
found under such circumstances, with the process of saponi- 
fication only just begun, it is tolerably certain that it could 
not have been long in the water, and vice versa. According 
to the same distinguished authority, an adult body requires 
an immersion in water for one year, before the conversion is 
complete ; and when it is buried in wet earth, a period of three 
years may elapse before the change is completely effected. 

An adipocerous body is always heavier than an ordinary 
one, because the adipocere is more weighty than the original 
fat. 



62 MEDICAL JURISPRUDENCE. 

Mmninification. — This constitutes another process by 
which the ordinary putrefaction of the body is interfered 
with. By mummification we understand the complete desic- 
cation, or drying up of the body. A mummified body is the 
result either of burial in an arid and sandy soil of hot coun- 
tries, such as those of Arabia and Egypt, or of the exposure 
of the body to a constantly cold and dry atmosphere — where, 
for instance, it is placed in a vault, through which a constant 
stream of dry, cold air is pouring. Such a condition of 
things is found at the Hospice of St. Bernard, in Switzerland. 
In the charnel house attached to this establishment, the 
bodies of those who have perished in the snows are placed. 
The atmosphere is so constantly cold and dry, that the flesh 
and fat completely dry up. It is quite impossible, from the 
mere inspection of a mummy, to venture an opinion as to 
the length of time that has elapsed since death. Some of 
the Egyptian mummies are from two to three thousand 
years old, as is shown by the inscriptions upon their burial 
cases. 

There are certain agents which retard, and others which 
promote, decomposition. The former comprise the various 
antiseptics. Lime, although popularly supposed to hasten 
putrefaction, in reality retards it, as is shown by a simple 
experiment of Dr. John Davy, who buried a piece of raw 
flesh that had been first covered over with powdered lime. 
It continued sound much longer than another piece that was 
buried without the hme. No doubt, the lime here served 
the purpose of secluding the atmospheric air. The strong 
acids and alkalies, although they do not hasten putrefaction, 
promote dissolution through chemical action, and in this 
way they aid in the removal of a body. 

The period and method of Inter me7it very materially influ- 
ence the rapidity of putrefaction. Thus, if decomposition 



HOW LONG SINCE THE DEATH ? 53 

has already set in before burial, this action will progress far 
more rapidly afterwards, than in a body which was interred 
before putrefaction was begun. Again, the depth of the 
grave and the nature of the soil exercise a very marked 
influence on the subsequent decomposition of the body, as 
already pointed out. Finally, the cause of death — as from 
a wasting disease, more especially when the blood has been 
deteriorated, as in typhus fever, etc. — will materially influ- 
ence the subsequent rapidity of the decomposition of the 
body. 

11. Having disposed of the first medico-legal question — 
is the death real or apparent ? we may consider the second 
important query — how long a time has elapsed since the 
death ? This is to be determined, in the absence of direct 
evidence, solely by attending to the different " signs " or 
phenomena of death already described. The inferences may 
be drawn, first, from the signs occurring before putrefaction, 
secondly, from those occurring after it. 

(i) Inferences from the signs exhibited before putrefaction. — 
If the body is only slightly cold, and rigidity is just com- 
mencing about the jaws, the eyes glazed, and the eyeballs 
sunken ; death has occurred, most probably, from a quarter 
of an hour to four or five hours. (The inference can never 
be more than approximative.) 

Suppose the body to be perfectly cold (externally) and 
rigid throughout: it has probably been dead from twelve 
hours, to three or four days. If rigidity is complete over 
the body, and cadaveric lividity (suggillation) is manifested 
over the surface, death has probably occurred from one to 
four days. 

The importance of attending to the above phenomena, by 
the medical jurist, is shown by a case mentioned by Taylor, 



54 MEDICAL JURISPRUDENCE. 

which occurred in London some years ago. A man named 
Gardiner was convicted and transported for killing his wife. 
The woman was discovered, with her throat cut, at 8 o'clock 
in the morning. She was very rigid throughout the upper 
part of her body, and the whole body was cold. The 
prisoner was able to prove an alibi between the hours of 4 
and 8 A. m., and his counsel endeavored to show that the 
post-mortem coldness and the partial rigidity might have 
developed within four hours, which, if true, would have 
exculpated the accused. But this point was very properly 
overruled by the mass of medical testimony to the 
contrary. 

(2) hiferences after putrefaction. — Suppose the body 
exhibits the greenish discoloration on the abdomen, the 
peculiar odor of putrefaction ; the rigor mortis has passed 
off, and the body is cold but pliant : death has occurred from 
one to three days, in summer, and from three to six or 
eight days, in winter. 

If the greenish-yellow discoloration extends more or less 
over the whole surface, together with greenish-brown stains, 
and dark red lines over various parts, along with relaxation 
of the sphincter ani muscle, it must have been dead from 
eight to ten days, in summer, and from ten to twenty days, 
in winter. 

If blebs are found over the skin, and some of them 
opened, with maggots in the muscles ; if the body is green 
all over, and the chest and abdomen are enormously dis- 
tended ; the nails loose or falling out ; the color of the eyes 
not recognizable; the features very much swollen, then the 
death must have occurred from two to three weeks, in 
summer, or from four to five weeks, in winter. 

If the chest and abdomen have burst open and discharged 
their contents, and some of the bones are denuded of their 



INFERENCES AS TO TIME OF DEATH. 55 

fleshy coverings; the eyes enormously swollen; the body 
has been dead, probably, from two to four months. 

The above " inferences," it will be remembered, are only 
approximative, as already stated. They cannot be positive 
under any circumstances; and, moreover, they are predicated 
on the supposition that the body under examination has not 
been buried, but exposed to the action of the atmosphere. 
It is important that the legal physician should avoid giving 
a very positive opinion on this question, as it must, at best, 
be but conjectural, and dependent on so many contingencies. 



56 MEDICAL JURISPRUDENCE. 



CHAPTER III. 

MEDICO-LEGAL INVESTIGATIONS.— THE POST-MORTEM. 

RESPONSIBILITY INVOLVED IN MAKING THE POST-MORTEM. — GENERAL 
ACCURACY AND METHOD NECESSARY. — EXAMINATION OF THE SUR- 
ROUNDINGS OF THE BODY. — EXTERNAL EXAMINATION OF THE 
BODY. — INTERNAL EXAMINATION OF THE BODY. — DETAILS OF THE 
EXAMINATION. — MEASUREMENTS AND WEIGHTS. — NOTES. 

The physician who undertakes to make a post-mortem 
examination in a medico-legal case, assumes a very serious 
responsibility. He should, therefore, be fully prepared to 
meet the various contingencies that may present themselves, 
and he should execute his work so thoroughly as to leave 
no cause for subsequent regret. He should, moreover, per- 
form his duty with strict impartiality, unbiassed by prejudice, 
and untrammeled by fear or favor. Not only should the 
examiner be an expert anatomist and pathologist, but he 
should also be a close and careful observer of all the sur- 
rounding circumstances that might throw light upon the 
case. 

In all cases where dispute is likely to arise, it is advisable 
to have two examiners, so as to avoid an ex parte appear- 
ance ; and the suspected person should be represented by 
a friend of his own selection. The examination should 
always, if possible, be made by daylight, since artificial light 
might conceal certain shades of color which it might be 
important to recognize, such as the stains of nitric acid. 

Where a chemical or microscopical investigation becomes 
necessary, the parts required should be carefully put aside 
for as early a subsequent examination as possible. 

The examination should always be exhaustive — leaving 



THE POST-MO RTRM. 57 

nothing undone — so that the examiner maybe able to testify 
accurately as to the cause of death. For example, the dis- 
covery of a disease of the heart (a sufficient cause of death) 
should not preclude an examination of the lungs and brain, 
in each of which the real cause of the death may be found 
located. So, also, the finding of poison in the stomach may 
co-exist with a ruptured aneurism, or a clot in the brain. 
The examination, moreover, should be conducted according 
to method, and all the details carefully recorded in a note- 
book. 

The post-mortem should be made as early as possible 
after the first day subsequent to the death. But it should 
never be declined on account of the interval that may have 
elapsed, nor even if the body be in a state of putrefaction. 

The surroundings should first claim attention, such as the 
locality where the body was discovered, as this may afford 
a clue to the criminal, especially in a case of infanticide. 
Sometimes the body has been dragged by the murderer to 
a distant spot, or the victim may have followed his assailant 
after receiving the blow, and died at a distance. The 
presence oi footmarks near by should be noted, together 
with their direction ; evidences of struggling, as denoted by 
the condition of the grass, or dust, or mud in the road ; the 
presence of any weapon, or other missile. If in a room, the 
position of the body in reference to articles of furniture, to 
any weapon, to glasses, cups, bottles, etc., from which poison 
may have been taken. It is also advisable to make a sketch, 
or rough drawing of the locality. 

As regards the body itself, the examiner should note its 
exact position when found : this is especially important if 
death was caused by a wound. The clothes should be care- 
fully examined, whether torn or cut; whether marked by 
blood-stains, or by any acid ; if stabbed, whether the cuts 
4 



58 MEDICAL JURISPRUDENCE. 

correspond with the wounds on the body. The clothes 
should then be removed, and the whole body minutely 
inspected. It should also now be identified, if possible. 
Notes should be made of the sex, height, weight, age and 
general development; of scars and other marks; abnormali- 
ties ; blood, seminal and other stains ; the color of the skin, and 
condition of the eyes and teeth; the temperature and rigidity 
of the body ; the degree of putrefaction ; lividity and ecchy- 
moses ; matters flowing from the nose and mouth; state of 
the tongue ; expression of the countenance. The ha7ids should 
be inspected, to ascertain if they hold a weapon — whether 
loosely or tightly grasped; or if portions of hair or clothing 
are firmly held (denoting a struggle); whether stained with 
blood, or blackened by powder (the latter indicating fire- 
arms); the presence or absence oi foreign bodies in the nose, 
mouth, anus and vagina should also be noticed. 

All wounds should be carefully examined, as to depth, 
extent and direction, and whether they suit the weapon that 
may be found near by; the condition of their edges, as 
indicating whether recent or not; marks of inflammation, 
suppuration or gangrene ; whether any foreign body be 
present, as a ball, fragments of clothing etc. The scalpel 
may be used, if necessary, to enlarge the wound, with care 
not to interfere with its original character. If there is 
contusion without solution of continuity, the examiner 
should not fail to look for internal injuries. 

\vi fractures and luxations, notice their condition, and that 
of the surrounding parts. In case of burns, observe their 
degree and extent; whether merely inflamed or vesicated, 
and the state of the adjacent parts. 

In females, examine the genital organs, in cases of rape, 
pregnancy, and recent delivery. 

In nezvborn children, ascertain their length and weight, 



INTERNAL EXAMINATION OF THE BODY. 59 

condition of the hair, nails, membrana pupillaris and genital 
organs, condition of the umbilical cord. The question of a 
live-birth will be a subject for future investigation. 

The Internal Examination of the Bodj/.— -The following 
order should be observed : — 

(i) The Head. — After a careful external examination for 
wounds or injuries (for which the hair may have to be re- 
moved), the scalp should be separated by an incision made 
across it from ear to ear, down to the bone ; it should then 
be everted in both directions, so as to expose the skull. 
Now look for fractures, and do not mistake irregular sutures 
for these. Notice any unusual thinness of bone ; follow out 
any fracture to its whole extent ; observe any extravasation 
of blood under the scalp. 

The skull should now be carefully sawed around, about 
half an inch above the opening of the ear, the calvarium 
removed, and the condition of the dura mater noticed. This 
membrane should be carefully cut around with a probe- 
pointed scissors, and the arachnoid and pia mater closely 
inspected 

The upper part of the brain can now be examined before 
removal — as to congestion of its vessels, laceration, or 
extravasation of blood upon its surface. (Remember this 
latter is often seen on the side opposite to the external 
injury.) The brain is now to be carefully removed, by 
inserting the fingers beneath it, and dividing the medulla 
oblongata. 

The base of the skull should be carefully inspected for 
fractures, which otherwise might escape notice. 

The brain should now be examined from above, slicing 
it horizontally; regarding specially its consistence, color, 
presence of extravasated blood or serum, of tumors or 
abscesses, disease of blood vessels, or of the membranes. 



60 MEDICAL JURISPRUDENCE. 

In opening the skull of very young children, a pair of strong 
scissors may be used instead of a saw. 

(2) The Spinal Column should be opened through its 
whole extent, by sawing through on each side of the spinous 
processes. The cord, together with the dura mater, should 
then be removed and examined. The presence of fracture, 
dislocation, or contusion, should be carefully noticed. 

(3) The Neck should be carefully inspected for marks of 
violence by the fingers (garrotting) ; by a cord (strangling 
or hanging) ; ecchymoses ; the great vessels, whether full or 
empty; the nerves, whether in their natural state. The 
cavity of the mouth and nose. The condition of the larynx, 
trachea, pharynx and oesophagus. 

The thorax and abdomen may be opened together, by a 
single incision, extending from the root of the neck to the 
pubes, and a transverse one across the umbilicus. The 
thorax should be first examined, except in the bodies of 
new-born children, where it is important to observe the con- 
dition of the diaphragm ; in this case the abdomen should 
first be opened. Moreover, in cases of death from asphyxia, 
it is recommended by Dr. Tidy to examine the condition of 
the heart before opening the head, because the blood is apt 
to escape from the right side of the heart if the head is 
opened first. 

(4) The Thorax. — The cartilages of the ribs, together with 
the sterno-clavicular ligaments, should be carefully divided, 
avoiding wounding the large veins of the neck, and the 
sternum should be reflected. Notice the condition of the 
lungs, whether adherent, collapsed, or emphysematous. 
Record immediately the position and color of the thoracic 
viscera ; also the presence, and amount, and nature of any 
fluid in the pleural cavity. Open the pericardium, and note 
the presence and amount of any contained fluid. 



INTERNAL EXAMINATION OF THE BODY. 61 

The lungs are removed by passing the hand beneath them 
(noticing any adhesions), and cutting through the bronchi 
and vessels at their roots. They should be inspected as to 
their color, density, etc., as indicating disease ; the condition 
of the bronchial tubes and pulmonary artery (embolism); 
and the presence of foreign matters in the air passages (in 
case of drowning). If blood has escaped into the thorax, it 
should be removed by a sponge, so as to ascertain the color 
of the parts. The hydrostatic examination of the lungs in 
new-born children will be considered farther on. 

The Heart should be examined in situ, before removal, 
as to its size, and the fullness of the coronary vessels ; the 
cavities should now also be opened, and the amount of their 
contained blood noted, together with any clots or polypi. 
The organ may next be removed by cutting through the 
vessels at its base, and examined as to its weight, condition 
of its walls and tissue, and state of its valves. Sometimes 
a microscopic investigation may be required. The aorta 
should likewise be examined, for atheroma and aneurism. 

(5) The Abdomen. — On removing the integuments, the 
examiner should carefully note all signs of peritonitis^ and 
of swelling, extravasation, strangulation, or twist of the 
intestines, and hernia ; likewise the condition of the liver, 
spleen, kidneys, bladder ; and, in the female, the state of the 
vagina, uterus and ovaries, the uterus especially, for evidences 
of pregnancy, abortion, and delivery. 

The Stomach should be examined by first ligating it at 
the cardiac extremity, and then by applying two ligatures at 
the pyloric end, and cutting between them. Note the general 
external appearance, and then open it along its lesser curva- 
ture. Examine the contents, as to quantity, character and 
odor, and reaction. Carefully inspect the lining membrane 
with a lens, for solid particles of phosphorus, crystals, or 



62 MEDICAL JURISPRUDENCE. 

patches of arsenic, or other mineral poisons, fragments of 
leaves or seeds, or other foreign matters. Note any evidences 
of inflammation, or ulceration. 

The Intestmes should next be examined, by removing them 
from their attachments, and slitting them throughout with 
an enterotome ; looking for inflammation and ulceration of 
the glands, and for any foreign matters ; also noting the 
condition of the appendix vermiformis. In cases of poison- 
ing, the stomach and its contents should be preserved for 
chemical examination, in a separate jar. The intestines also 
(at least a portion of the small and large bowel, together 
with the rectum), and portions of the liver, kidney and 
spleen, should be kept for a similar purpose. The jars con- 
taining the viscera should be securely stoppered, and sealed 
with the private seal of the examiner, with a label affixed, 
stating the name of the deceased person, the date of death 
and of the autopsy. They should then be delivered per- 
sonally, by him, to a responsible party, from whom he 
should always take a written receipt. 

In case of disinterment of a body, the inspectors should 
always view it before it is removed from the coflin ; at which 
time, also, it should be properly identified by the friends or 
relatives of the deceased. 

In a medico-legal examination of a body, such as above 
described, there should always be present either a second 
inspector, or a clerk, to take down the notes as the autopsy 
progresses. These notes should comprise the appearances 
presented by the different organs, stating only facts, but no 
opinions. The notes should be carefully read over by both 
examiners before sewing up the body, and, if necessary, 
corrected. A report should then be carefully drawn up, 
containing the opinion of the case, as deduced from the 
ascertained facts, with the reasons therefor, clearly and 
succinctly stated, but avoiding all theorizing on the subject. 



PRESUMPTION OF DEATH. 63 



CHAPTER IV. 

PRESUMPTION OF DEATH, AND OF SURVIVORSHIP. 

CASES INVOLVING PRESUMPTION OF DEATH, AND OF SURVIVORSHIP. 
— FRENCH LAW OF SURVIVORSHIP. — PROBABILITIES AFFORDED BY 
AGE, SEX, AND MODE OF DEATH. 

Presumption of Death. — This question may be raised when 
a person goes away from home, and is not heard of for many 
continuous years. The law will, in that event, regard him 
as dead, or presume his death, and his administrator or 
executor may proceed to settle his estate. The question 
under this form is not unfrequently raised in life insurance 
companies, where the party insured has not been heard of 
for many years, and his lawful heirs demand the payment 
of his policy. It must also be considered in cases where 
a husband deserts his wife, or vice versa; or where either 
married person leaves the other, and remains continuously 
away ; or where the party going away without the inten- 
tion of remaining, is not afterwards heard of for a succession 
of years. 

The length of time usually regarded as legally warranting 
a presumption of death, in any of the above cases, is seven 
years from the time the person was last heard from; so that 
in the case of married persons, it is not regarded as bigamy 
if the other party should marry again after the expiration 
of the seven years of continuous absence, without being 
heard from, or being known to be alive. In cases of heir- 
ship and property, and in some cases of life insurance, it is 
often not considered necessary to wait the whole seven years, 
but a settlement has been made by the courts or company 
in two years. 



64 MEDICAL JURISPRUDENCE. 

The presumption of death must depend on general 
evidence, being a presumption oi fact to be determined by 
a jury. There are cases, however, of a special character, 
where the courts have decided the presumption of death to 
be sooner or later than the period of seven years, as, e. g., if 
the individual concerned was in feeble health when he, or 
she, was last heard from. This question would involve 
medical evidence as to the probabilities of life, in such a 
case. 

Pi'esitmption of Stirvivorsldp. — Questions relating to pre- 
sumption of survivorship are much more frequently discussed 
in the courts than those pertaining to presumption of death. 
There is, however, no general law upon the subject, either 
in this country, or Great Britain, every case in which the 
question is involved being decided according to its indi- 
vidual merits. When two or more persons perish by the 
same calamity, in the absence of all testimony, the courts 
frequently refuse to assume that one survived the others, 
but have decided that all perished together. Yet, very 
momentous questions may be dependent upon a legal deci- 
sion of the question of survivorship; as when the parties 
dying are a father and a son ; if the son survive but for a 
moment, " his wife shall have dower, for the lands descended 
the instant the father died." So, in the case of a testator 
and legatee ; if the latter dies first, the legacy lapses ; but if he 
survives the testator, for ever so short a time, his executors 
can claim. So, again, the husband of a woman possessed 
of freehold property (not specially settled), has a life interest 
in her estate^ provided she has issue by him, born during 
the life of the mother, and which survives her even for a 
moment of time (tenancy by conrtcsy). The old Roman 
law upon this subject, upon which are based most of our 



PRESUMPTION OF SURVIVORSHIP. 65 

modern decisions, enacted that when persons of different 
ages perished in battle, those under puberty were deemed 
to have died first ; but if the son was above the age of 
puberty, and both died together, the son was presiuncd to 
have survived the parent. In the case of husband and wife, 
the husband was presumed to be the survivor (Beck). 

According to Fodere and Beck, the French law, as con- 
tained in the Code Napoleon, is as follows : 

" I. If several persons, naturally heirs of each other, perish 
by the same event, without the possibility of knowing which 
died first, the presumption as to survivorship shall be deter- 
mined by the circumstances of the case; and in default 
thereof, by strength of age and sex. 

''II. If those who perished together were under fifteen 
years, the oldest shall be presumed the survivor. 

'* III. If they were all above sixty years of age, then the 
youngest shall be presumed the survivor. 

" IV. If some were under fifteen, and others above sixty, 
the former shall be presumed the survivors. 

" V. If those who perished together were over the age of 
fifteen, but under sixty, the males shall be presumed the 
survivors, where the ages are equal, or the difference does 
not exceed one year. 

"VI. If they were of the same sex, that presumption shall 
be admitted which opens the succession in the order of 
nature. Of course, the younger shall be considered to have 
survived the elder." 

According to Section IV in the above Code, no distinc- 
tion is made between an infant and a man of sixty years ; 
3^et certainly, it may fairly be supposed (as remarked by Dr. 
Tidy) that the latter had a better chance of life than the 
former. The Prussian law on this question is about iden- 
tical with the Code Napoleon. 
4* 



66 MEDICAL JURISPRUDENCE. 

Although our laws are not decisive on questions of pre- 
sumption of survivorship, but treat them as questions of 
fact depending wholly on evidence, and, in the absence of 
all evidence, regarding them as matters incapable of being 
determined, still, there are certain matters of importance 
connected with each case as it presents itself, which deserve 
the consideration of the court and jury, in influencing their 
decision. These points may be considered under the follow- 
ing heads : 

(i) Probabilities afforded by tJie Age. — Between a father, 
and a child under puberty, the English civil law decides the 
father to be the survivor. Between the ages of fifteen and 
sixty, there is no probability. Between a middle-aged man, 
and one under fifteen and over sixty, the probabilities are in 
favor of the former. Between one under fifteen and one 
over sixty, the former is deemed the survivor ; but the same 
exception might be taken here as in the case of Sect. IV of 
the Code Napoleon (siiprd). Between two under fifteen, the 
oldest is considered the survivor. If the question is between 
a mother and infant, both dying in childbed, without assist- 
ance, the presumption of survivorship is in favor of the 
mother, because the child might be still-born, and also 
because, if large, its life might be endangered by delay, and 
it would be more exposed to danger without assistance, 
such as strangulation by the cord, or suffocation in the 
discharges of the mother. 

(2) Pres2imption afforded by the Sex. — The presumption 
is in favor of the male, when it is a question of physical 
strength and courage, as when a man and woman perish 
together by drowning, or some other casualty. But in par- 
ticular cases, the question of the respective health of the 
two persons might have to be considered. When, however, 
it is a question of passive endurance, especially where insen- 



PRESUMPTION OF SURVIVORSHIP. 67 

sibility supervenes, then the presumption is in favor of the 
female. 

(3) The Cause of Death, as affording a presumption of sur- 
vivorship. In death from asphyxia (apnoea), as in smother- 
ing, or breathing noxious gases, as women require less 
oxygen than men, the probabilities are in favor of the 
former, other things being equal. Thus, it is stated that, in 
Paris, in one year, there occurred three hundred and sixty 
cases of poisoning by charcoal vapors ; of this number there 
were nineteen instances where a man and a woman were 
exposed together, and of these only three survived, and all 
were females. Dr. Beck relates the case of a man, wife and 
child, who were all asphyxiated while sleeping in a room 
which Avas exposed to the vapors of a coal stove. In the 
morning, the man was found dead, the child dying, but the 
woman recovered. «fe 

In drowfiing, or shipwreck, the question becomes very 
complicated, having to take into the account age, sex, 
strength and opportunity. Thus, men, being stronger, more 
likely to be able to swim, and, in case of shipwreck, being 
more apt to be on deck, and, therefore, in a better position 
to escape, have the best probabilities for survival ; but, on 
the other hand, the buoyancy of a woman's clothes might 
support her in the water, and thus save her life, under pos- 
sible circumstances. In case of two or more persons, all 
males, equally exposed, a presumption of survivorship can 
only be entertained by searching for bodily injuries, or 
other weakening causes, which would necessarily interfere 
with the individual's exertions to save his life. Here, also, 
their respective swimming capacities would have to be con- 
sidered. 

If the question be on the survivorship, in the case of 
several persons exposed to excessive cold, the amount of 



68 MEDICAL JURISPRUDENCE, 

clothing, the physical condition, and the immoderate use 
of alcohol, must all be considered before arriving at a con- 
clusion. The probabilities would here be in favor of the 
strong adult over the very young, or very old person, and 
of males over females. The debilitating effects of poverty, 
entailing a bad nutrition, and also of intoxication, as being 
especially obnoxious to the effects of cold, should not be 
overlooked. The perishing of drunken people on a cold 
winter's night is a too familiar occurrence. In relation to 
the effects oi heat, it maybe remarked that, while the young 
and old suffer more from cold than adults, they seem able 
to withstand a greater amount of heat than the latter. 

In death by starvation, the general principle that the 
young require more food than the aged, will determine the 
presumption of survivorship to be in favor of the latter; 
also for the female, rather than the male. Certain circum- 
stances, however, should here be considered, such as prox- 
imity to water, which would aid in sustaining life for some 
time, even without food. 



PERSONAL IDENTITY. 69 



CHAPTER V. 

PERSONAL IDENTITY. 

SECTION I. 

IMPORTANT MEDICO-LEGAL BEARINGS. — I. IDENTIFICATION OF THE 
LIVING. — PERSONAL APPEARANCE. — PECULIAR BODILY MARKS. — 
REMARKABLE CASES. 

The medico-legal consideration of the subject oi personal 
identity is much more important than it may appear at first 
sight. The question is often raised in trials, both of a civil 
and criminal character, and it may constitute the chief link 
in the whole chain of evidence. Cases of mistaken identity 
are constantly occurring, and proofs abundant might be 
adduced to show that innocent persons have frequently 
been made to suffer the penalty of death judicially, instead 
of the guilty, simply through an error of this nature. Should 
an alleged child, or other claimant present his claim to an 
inheritance, he must first establish his identity before taking 
further steps in the suit. Is an individual assaulted, or 
robbed? he will be required to identify his assailant before 
he can successfully prosecute him. Or, again, a person, 
after many years' absence in foreign climes, returns home to 
claim his rightful property or title, but he is so changed as 
to be unrecognized by his nearest relatives ; he must be abje 
to prove his identity before the courts, before his claim can 
be sustained. And then, in relation to persons found dead — 
whether in cases of recent death, where the body has under- 
gone but little change, or years after the decease, where 
nothing remains of the body from which to glean the im- 
portant information but the bare skeleton — the question of 



70 MEDICAL JURISPRUDENCE. 

personal identity acquires the most intense interest, more 
especially in a trial for murder, where it becomes essential 
to establish the identity of the alleged victim as the corpus 
delicti. 

It is true that the aid of the physician is not so frequently 
invoked for proving the identity of the living, since this 
can generally be established as satisfactorily by friends and 
neighbors, as by medical men. Still, there may be occa- 
sions of unusual complexity, in which a professional opinion 
may become requisite, as, for example, to verify certain 
deformities, fractures, scars, and other marks about the 
person, when these constitute the evidences on which the 
identification may be dependent. 

The subject will be considered under the two divisions of (i) 
The Identity of the Living, and (2) The Identity of the Dead. 

I. The Identity of the Living. — This may usually be es- 
tablished by the direct evidence of witnesses who have 
known the individual sufficiently long to have a distinct 
recollection of his personal appearance; such is the testi- 
mony of relatives, friends and acquaintances. Although 
among the myriads of the human family it is very rare to 
find two persons exactly alike in all points, yet remarkable 
instances do occasionally occur where the personal resem- 
blance is so striking as to baffle even the skill of the detect- 
ive ; and this resemblance has been made still stronger by 
the existence of similar marks, cicatrices, or certain peculi- 
arities of structure, in both individuals. Some striking illus- 
trations might be given of the extreme difficulty — amounting, 
at times, to an impossibility — of deciding the question, which 
also go to show how easily witnesses may be mistaken in 
their evidence on this subject. Only two will be here re- 
ferred to. 



IDENTITY OF THE LIVING. 71 

In the year 1560 the celebrated case of Martin Guerre 
and Arniand du Tilh was tried before the Parhament of 
Toulouse. Martin had been absent from his home for eight 
years, when the person named du Tilh appeared, and 
represented himself as the long absent man. So strong 
was the resemblance, that his statement was universally 
accepted by all of Guerre's family, including his wife, four 
sisters and two brothers-in-law, among whom he lived 
unsuspected for three years. About this time, however, 
something occurred to excite suspicions as to the true 
character of the supposed husband and brother, when he 
was arrested, and brought before the tribunal, on a charge of 
fraud. Upon his examination he gave satisfactory answers 
to the most minute questions in relation to Guerre's former 
life. Some one hundred and fifty witnesses were examined 
during the investigation, of whom between thirty and forty 
testified, from a life-long acquaintance, that the prisoner was 
Martin Guerre ; while about the same number swore posi- 
tively that he was Armand du Tilh, whom they well knew ; 
and over sixty, who knew them both, declared that they 
were unable to say which the prisoner was. Finally, how- 
ever, the real Martin appeared upon the scene, when imme- 
diately he was recognized. The four sisters who had 
previously testified that du Tilh was their real brother, now 
admitted their error, and acknowledged the distinction. 
There being now no doubt of the guilt of the prisoner, he 
was condemned, and afterwards executed. (Wharton and 
Stille's Med. Jurisp. Vol. II, p. 1092.) 

The other instance is afforded in the recent famous 
Tichborne case, in which a person named Orton, with 
various aliases, undertook to personate an English baronet, 
heir to a large entailed estate. So successful was his scheme 
that "he was sworn to be Sir Roger Tichborne by eighty- 



72 MEDICAL JURISPRUDENCE. 

five witnesses, among whom were Sir Roger's mother, the 
family soHcitor, one baronet, six magistrates, one general, 
three colonels, one major, two captains, thirty-two non- 
commissioned officers and privates of the army, four clergy- 
men, seven tenants of the Tichborne estates, and seventeen 
servants of the family." The claimant also gave proof of 
** a fish-hook wound on the eye, of a mark of bleeding on 
the ankle, and of a peculiar scar on the head," all of which 
the genuine Sir Roger possessed. The case, however, broke 
down on cross-examination, many circumstances being 
proven against the claimant, which need not be here 
enumerated. Suffice it to say that a verdict was taken 
against him, and that an indictment was since found against 
him for perjury. 

Now, as a fair inference from the above two instances, 
and other remarkable cases, we may assume, that appear- 
ances are not conclusive evidences of personal identity ; and, 
as a sufficient reason for this we must admit the fact that 
" a large proportion of ordinary persons are very untrust- 
worthy witnesses to identity, when dependent on appear- 
ances alone. They are, from nature or habit, incapable of 
appreciating fonn, and form alone is the unerring proof of 
personal identity. The difficulties in the way of identifica- 
tion, more especially of the dead, are to them insuperable " 
(Lond. Spectator). To this inherent difficulty on the part 
of the witnesses, may be added, their want of previous 
training as minute observers ; and also, the well-known 
fact of the adroitness of criminals at personal disguisement. 

A second means of establishing the identity of the living, 
especially in a criminal, is by certain peculiarities in the 
appearance, which are noticed at the time of the commission 
of the crime, and which are, therefore, apt to leave a strong 
impression on the senses, — such as {ex) si::e, when the indi- 



IDENTITY OF THE LIVING. 73 

vidual is very tall or very short, very corpulent or very 
slim ; whether lame, or otherwise deformed ; (d) dress, 
when a portion — sometimes a mere shred — of the prisoner's 
dress is discovered near the seat of the crime, which ex- 
actly corresponds with the rest of the garment found on 
his person, or in his own house. 

A third means of identification is afforded by the voice. 
Peculiarity of the voice (such as depth or shrillness, lisping 
or stammering) always makes a strong impression upon 
those who hear it, and constitutes a valuable aid in personal 
identification. 

Fourthly, the presence of certain pectiliar marks, either 
natural or acquired, about the person, often affords material 
aid in establishing identity. These marks comprise moles, 
naevi, scars, cicatrices, deformities, fractures, tattoo-marks, 
etc. Such marks are usually well known, and remembered 
by relatives and friends of the individual, who can usually 
identify them. Some of these remain upon the body 
during life ; others gradually decline and fade away. In 
relation to tattoo-marks, Prof Casper's experience leads to 
the inference that some of them (the red ones) are gradually 
obliterated by time, while the black and purple ones are 
more permanent. A cicatrix is permanent during life, if 
there has been any original loss of substance. It may not 
always be distinguished from the surrounding skin, unless 
the part be smartly rubbed, when the white scar is immedi- 
ately manifested on the red surrounding surface. Caution 
should be given against too strong a reliance upon scars as 
a means of identity, since these may, at times, be dis- 
covered upon another, precisely similar, both as to form 
and situation. 

Under this head may be mentioned the appearance of 
the hands (whether hard and horny, or soft and pliant, or 



74 MEDICAL JURISPRUDENCE. 

whether stained in a peculiar manner), as often indicating 
the nature of the occupation of the individual. 

Photographs and other portraits of the suspected person 
are sometimes useful aids in the identification of the living, 
as well as of the dead; but caution is requisite here, since 
the art of the photographer in the touching up of the picture 
frequently makes it an unfaithful representative of the nega- 
tive. 

As bearing upon this subject, it may be proper to say a 
few words upon vision and hearing. The following remarks 
are abridged from Woodman and Tidy's Forensic Medici^ie. 
The limits of normal vision or healthy sight, unassisted by 
instruments, in a perfectly clear atmosphere, are as follows : 

At a height of 5 feet, the range of distance is 2.96 miles. 
" 20 " " " 5.91 

50 " " " 9-35 

a 100 " " " 13.2 

" 500 " " " 29.5 

" 1000 " " " 41.8 

" 5000 " " « 94 

It follows from this, that a man of ordinary height may be 
seen on level ground at a distance of two or three miles, on 
a clear day ; but this is very different from recognition of the 
person, so as to identify him. The effects of age upon the 
acuteness of vision is considered by Dr. De Gueret to be as 
follows : — 

At fifty years it is diminished one-fifth ; at sixty years 
one-fourth; at seventy years, one-third; at eighty years, 
one-half In other words, if a man of thirty or forty could 
distinguish an object at one hundred feet distance, at sixty 
years of age he could not recognize it further off than 
seventy-five feet, or, at eighty years, at fifty feet. 

The recognition of persons at a nearer or greater distance, 
is afforded by their stature, gait, complexion, color of the hair 



IDENTIFICATION BY SIGHT AND SOUND. 75 

and eyes, and peculiarities of appearance. According to the 
above authority, the best-known persons can be recognized 
often with difficulty, in broad daylight, at one hundred 
metres, or about one hundred and nine yards. Less known 
persons may be recognized, in broad daylight, at sixty to 
one hundred yards ; and people who are almost strangers, 
and who have no personal peculiarities, at twenty-seven to 
thirty-three yards. By the clearest moonlight, the best- 
known persons cannot be recognized further off than six- 
teen or seventeen yards. By starlight, recognition cannot 
be effected beyond ten to thirteen feet. The light oi 2. flash 
of lightning enabled a lady, on her passage home from India, 
to see distinctly the features of a man who was robbing her 
trunk in the cabin of a vessel, on a very dark night; and 
authentic instances are given where, by ih.Q flash of a pistol 
or gun, sufficient light was momentarily afforded to enable 
not only an assailant to be recognized, but likewise the 
color and appearance of his horse The subjective sensa- 
tion o{ flashes of light or sparks, produced by a blow upon 
the eyeball, has no effect whatever in aiding recognition ; 
since the same sensation is often experienced by those who 
are totally blind. 

The distance at which sounds (such as the report of a 
gun or pistol) continue to be audible cannot be determined 
with accuracy, since it depends upon the direction of the 
wind, the condition of the atmosphere as to moisture, and 
other disturbing sounds. The velocity of sound may be 
stated to be, on an average, 11 35 feet per second, which is 
about 13 miles a minute, or one mile in about 4^ seconds. 



76 MEDICAL JURISPRUDENCE. 

SECTION II. 

II. IDENTIFICATION OF THE DEAD. — MUTILATED REMAINS. — IDENTI- 
FICATION BY MEANS OF THE SKELETON, AS TO AGE, SEX AND 
STATURE. — RULES OF PROPORTION. — FRACTURES, DEFORMITIES AND 
CALLUS. — AGE OF BONES. — EXAMINATION OF HAIR AND FIBRES. 

The Identification of the Dead. — This may have reference 
(i) to the body recently dead; and (2) when the soft parts 
have disappeared by putrefaction, and the skeleton only 
remains, or where detached bones merely have been dis- 
covered. 

When the death has but recently occurred, and the body 
is unmutilated, most of the same general methods of estab- 
lishing identity are available as have already been mentioned 
in the case of the living, — such as the testimony of relatives 
and acquaintances as to the personal appearance of the 
deceased, certain marks upon the person, as naevi, moles, 
cicatrices, tattoo-marks, fractures, deformities, etc. Photo- 
graphs and other portraits are here also admissible, although 
by no means reliable proofs. 

If the body has been subjected to mutilation after death, 
and the severed portions removed to a distance from one 
another, and some of them even destroyed, as is sometimes 
done by a murderer with a view to escape detection, the 
difficulty of identification is, of course, very much increased. 
Nevertheless, if the disconnected parts can be recovered, or 
even a portion of them, it will always be possible for a 
skilled anatomist so to readjust them, as to build up again 
the body, so to speak, by making the proper allowance for 
the missing parts, and comparing these with other average 
specimens of a similar kind. Several striking examples of 
this character are given in the books. One of these is the 
well-known case of Dr. Parkman, who was murdered by 
Dr. Webster, in Boston, Mass., about thirty years ago. 



IDENTIFICATION OF MUTILATED REMAINS. 77 

After the death of his victim, Dr. Webster attempted to 
destroy all evidences of the deed by cutting up the body 
into fragments, some of which were burned in a grate, some 
immersed in chemicals and others packed away in boxes in 
distant parts of the building. On the discovery of these 
remains, a week after the murder, the portions of the body 
were accurately examined by a skilled anatomist. It was 
proved that they were human remains, belonging to one 
and the same body ; of the male sex ; and that they had not 
been dissected for anatomical purposes, but cut and hacked 
in different directions, for the object, evidently, of mutilation. 
On restoring these disjointed parts in situ, and supplying 
the deficient portions, it was found that the proper measure- 
ments agreed closely with those of the missing Dr. Park- 
man. This circumstance, together with the discovery of 
certain marks of identity about the teeth and jaws (the head 
had been almost completely destroyed by fire), afforded 
sufficient evidence of the personal identity of the missing 
gentleman to enable the jury, on the trial of Dr. Webster, 
to find a verdict of guilty. Another instance of a somewhat 
similar nature is recorded by Professor Taylor, in his Medi- 
cal Jurisprudence. A number of years ago a murder was 
committed in London, on the river Thames, and shortly 
afterward a package containing mutilated human remains 
was discovered on one of the abutments of Waterloo bridge. 
The murderer had, no doubt, intended to throw the bundle 
into the river, but it had lodged on the projection in its 
descent. Dr. Taylor was requested to examine and identify 
these mutilated remains ; and when, after great difficulty, 
the parts were brought together and found to fit, the body 
was identified as that of a man who had recently disappeared 
from a vessel on the river — a Swedish sailor. 

When the question of identity relates to the skeleton 



78 MEDICAL JURISPRUDENCE. 

merely, or only to portions thereof, the answer cannot be 
always satisfactory, and the medical jurist has need of much 
caution and reserve before giving a positive opinion. 

The very first thing for him to determine Is, whether the 
bones submitted to his inspection are human bones, or those 
of some of the Inferior animals. Doubtless, if the entire 
skeleton be discovered, there need be no uncertainty about 
the matter ; but if only a single bone or two be found, a 
mistake may easily be made, except by a practiced anatomist 
and osteologist. Indeed, many ludicrous blunders are 
recorded, of persons of otherwise good medical education 
mistaking the bones of the ox, horse, dog, pig and goat for 
those of the human subject. But may not something be 
learned by the aid of chemistry, or the microscope ? The 
reply must be, generally. In the negative. Certainly the 
bones of the aged do contain more calcareous matter than 
those of the young, and consequently present a somewhat 
different appearance under the microscope. But human 
bones have the same general chemical composition as those 
of the lower animals. It is also true that the bone-cells or 
corpuscles vary somewhat In size in the different orders of 
animals, being largest in reptiles, smallest in birds and 
mammals, and Intermediate in fishes. In this respect there 
is an analogy with the size of the blood-corpuscles in these 
different orders. But these are only generalizations, and 
would be of little practical use in individual instances. To 
be sure, the microscope will enable us to determine the fact 
of any specimen submitted being bone^ or not, by the pre- 
sence or absence of the bone-cells ; but it can go no further, 
inasmuch as it cannot distinguish the bone-cell of a man 
from that of a mouse, or of an elephant. 

If the skull is the only portion of the skeleton submitted 
for examination, there can usually be no difficulty In recog- 



I 



DETERMINATION OF THE AGE. 79 

nizing it as human ; the only doubt that might arise would 
be the possibility of its belonging to one of the higher order 
of (anthropoid) apes ; but even here, there are important 
differences which would not be overlooked by one skilled 
in comparative anatomy and osteology. The further ques-- 
tion, whether from the examination of a skull simply, it is 
possible to decide to what race the individual belonged — 
Caucasian or otherwise — we do not think can be answered 
with absolute certainty. Doubtless, well-marked typical 
skulls may be identified as belonging to some particular 
race, e. g., the negro, or Caucasian ; but we must remember 
that the points of distinction, which in well-marked speci- 
mens serve to separate these, shade away in many instances, 
so as to make it extremely difficult, if not impossible, to 
give a medico-legal opinion in an isolated case. 

Another important point is to ascertain whether all the 
bones submitted for inspection belong to one and the same 
skeleton. The mere fact of their being discovered together 
does by no means necessarily prove it, since they might 
have been so placed either accidentally, or with the design 
of eluding detection of some crime. 

In the identification of the dead by means of the skeleton, 
or by detached bones, the three leading points to determine 
are (i) the age, (2) the sex, and (3) the stature. 

I. The Age. — This can generally, in young subjects, be 
pretty accurately determined by the development of the 
teeth, and by the progress of ossification in the different 
bones. In the skeletons of new-born children, and before 
the teeth have appeared, it may become important for the 
medical jurist to be able to decide upon the age, in order 
either to rebut or confirm a charge of infanticide. It is 
authoritatively stated that in the jaws of a child at full term 



80 MEDICAL JURISPRUDENCE. 

there will always be found the rudiments of twenty-four 
teeth — twenty primary teeth, and four permanent molars. 
Hence, if only the jaws of an infant be discovered, medical 
evidence of its probable age may be given. The average 
date of the eruption (cutting) of the teeth is, according to 
Mr. Bell, as follows : The four central incisors appear from 
five to eiglit months after birth ; the four lateral incisors, 
from seven to ten months; the four anterior molars, from 
twelve to sixteen months; the four cuspidati, ixova fourteen to 
twenty months; and the four posterior molars from eighteen 
months to three years. Between six and seven years the 
jaws contain forty-eight teeth — twenty temporary ones in a 
perfect state of development, and twenty-eight permanent 
ones imperfectly developed, and placed behind the tempo- 
rary teeth, which they are to replace. According to Mr. 
Saunders, the order in which the permanent teeth make 
their appearance is as follows: At seven years, the four 
anterior molars; at eight years, the four central incisors; 
at nine years, the four lateral incisors ; at ten years, the four 
anterior bicuspids; at eleven, \kvQ four posterior bicuspids; 
at twelve to twelve and a half years, the four cuspids ; and 
at thirteen to fourteen years, the four second molars — making 
the whole number of permanent teeth at this period to be 
tiventy- eight. The four remaining (posterior molars) teeth — 
called dentes sapientice — do not usually appear until eighteen 
to twenty-one years of age. As a rule, the teeth of the lower 
jaw are cut first, but there are many exceptions ; nor must 
it be forgotten that irregularities often occur as to the order 
of their appearance. The above description is intended to 
apply only to the average cases. 

Let us now take one or two examples to illustrate the 
medico-legal application of the foregoing rules. Suppose 
the skull of a child was discovered, in the jaws of which 



PROGRESS OF OSSIFICATION. 81 

were twelve permanent teeth — eight incisors and four 
molars, we should decide the age to be about nine years. 
If the jaws contained tzuenty-four permanent teeth — eight 
incisors, four molars, eight bicuspids and four cuspids, we 
should conclude the age to be about thirtee7i years ; and so 
on. It is proper here to remark, that there are two diseases 
which affect the growth of the teeth, viz., rickets and 
syphilis. In a rickety child, the first teeth do not usually 
appear until after the twelfth month, whereas in cases of 
congenital syphilis, the teeth appear prematurely — before 
the sixth month ; but they present a peculiar notched 
appearance ; and they are apt to be brittle and to crumible 
away easily. 

The progress of ossification in the different bones of the 
skeleton affords an additional test of its age, especially in 
early life. According to Beclard, the degree of ossification 
in the lower epiphysis of the femnr affords the most certain 
criterion of the age of the foetus, and of the new-born child. 
Thus, if no ossific deposit can be seen in this cartilaginous 
epiphysis, it is certain that the foetus has not attained to the 
eighth month of uterine life. If the osseous deposit is as 
large as a poppy-seed, it is probably in the ninth month of 
foetal existence ; and if it has acquired the diameter of a 
line and a quarter, to one and a half, it has reached tlie full 
period. If the point of ossification measures three lines or 
more, it may be assumed that the child had survived its 
birth some little time. 

The (average) length of the skeleton of a new-born child 
is about sixteen inches. At the end of the first year, ossi- 
fication has commenced at the extremities of most of the 
long bones ; and this progressively advances from year to 
year, until the whole process is completed ; and the epiphyses 
of all the long bones are united to their shafts at full 



82 MEDICAL JURISPRUDENCE. 

maturity, which, in the male, may be considered to be 
twenty-four years, and in the female, twenty-two years. 
After this period, or when ossification is once completed, 
it is difficult to determine the precise age by an examination 
of the bones of the skeleton. It should, however, be 
remembered that the different bones of the sternum do not 
unite until about the fortieth, or forty-fifth year ; and union 
between the sacrum and os coccygis is not usually com- 
pleted until fifty-five, or sixty years of age. 

In old age, the bones become lighter in weight, and more 
brittle, from the loss of animal matter. They are also 
darker in color; and the flat bones become thinner, from 
the absorption of their diploe. In the skull of the aged, the 
sutures are more or less obliterated ; and the remaining 
teeth present a worn appearance, and a yellowish color. If 
the teeth have been lost (as is usually the case, at least in 
this country), the alveolar processes become absorbed, and 
the lower jaw undergoes a well-marked change in its appear- 
ance, consisting of the widening of the angle at its neck, and 
the shortening of the vertical diameter of its body, or width, 
which imparts the characteristic senile expression to the 
mouth of the aged. The discovery of such a jawbone would 
positively determine the age to be about seventy years, or 
over. 

The presence or absence of certain teeth in the head has 
frequently been the means of determining the identity of 
the body. So also, the presence of artificial teeth, with 
their mechanical appendages, has at times furnished the 
strongest corroborative evidence in such identification, as 
in the celebrated Parkman-Webster case, already alluded to, 
in which the artificial teeth, discovered undestroyed by the 
fire in the grate, where the head had been burnt up, were 
positively identified by the dentist, who had manufactured 



IDENTIFICATION OF THE SEX. 83 

and fitted them some years before. So, likewise, the remains 
of the Marchioness of SaHsbury, discovered among the 
burnt ruins of Hatfield House, were identified by the jaw- 
bone having gold appendages for artificial teeth (Guy). The 
importance of the teeth as a means of identification is shown 
in the case of the late French Prince Imperial, whose body 
had been so much disfigured by his assailants, that its iden- 
tification would have been extremely difficult but for certain 
peculiarities about his teeth (Taylor, Prin. and Prac. Med, 
Jurisp., 1SS4). 

n. The Sex. — This can usually be determined from the 
skeleton, if entire, without much difficulty. The general 
appearance of the male and female skeleton presents many 
well defined points of difference, which need not here be 
enumerated, as they are described in all anatomical works. 
Suffice it to say that the corresponding bones of the two 
differ in size, weight, strength, and prominence of their 
ridges and protuberances which mark the points for the 
insertion of muscles. There are also certain recognized 
differences in the head and thorax; but it is in the pelvis 
that the most characteristic distinctions are observed. The 
male pelvis is narrower and deeper than that of the female. 
In the latter, the ossa illii are more spread out, and flatter, 
which renders the superior part of the pelvis more capa- 
cious; the sacrum is broader, and turned more backward; 
the arch of the pubis is much wider. The greatest diameter 
is the bilateral ; whereas in the male, the antero-posterior is 
the greater. The foramen ovale is triangular in the female ; 
in the male, it is more oval. Owing to the greater breadth 
of the female pelvis, the acetabula are farther apart than in 
the male. It is to be understood that these peculiarities 
in the female pelvis are not exhibited until the period of 



84 MEDICAL JURISPRUDENCE. 

puberty, and subsequently. From a fragment of a bone, 
merely, it would certainly be hazardous to undertake to 
determine the sex; and the medical jurist should exercise 
much reserve in giving an opinion in such a case. 

III. The Stature. — If the whole skeleton has been pre- 
served, and none of the ends of the long bones have been 
lost by decay, the original height may be calculated with 
tolerable accuracy by arranging the bones in situ, and adding 
an inch and a half, to two inches, to the entire length of the 
skeleton, to supply the loss of the soft parts. But even here 
perfect accuracy cannot be attained, chiefly on account of 
variations in the curve of the spinal column in different in- 
dividuals. Dr. Dwight* assumes, as the result of numerous 
observations, that the total height of the intervertebral carti- 
lages is 25.6 per cent, of the entire length of the spine. As 
a collateral aid in estimating the stature, we may regard as 
correct the generally accepted rule, that the top of the 
symphysis of the pubes is about the centre of the body in 
average women ; while in men, the centre is a little below 
the symphysis. 

The attempt has frequently been made to estimate the 
height of the body from a study of the individual long 
bones of the skeleton ; but no reliance can be placed upon 
such comparisons, inasmuch as there is considerable varia- 
tion in the length of these bones in skeletons of the same 
stature. The so-called "rules of . proportion " of certain 
writers cannot be regarded as by any means certain, or 
authoritative. In case the skull is wanting, the rule laid 
down by Dr. Gould is " to find the height of the spine of 
the seventh cervical vertebra from the ground, and add to 

* The Identification of the Human Skeleton, by Thomas Dvvight, m.d. 
Boston, 1878. 



IDENTIFICATION BY FRACTURES, ETC. 85 

this 9.95 inches, which is the average height from this point 
to the top of the head."* M. de St. Luca (Cosmos, October 
2d, 1863, quoted by Professor Taylor) states that an approx- 
imative estimate of the stature may be had by measuring 
the length of the third phalanx of the middle finger, 
thus: this phalanx is equal in length to one-fourth that 
of the whole finger, or one-eighth that of the hand, in- 
cluding the carpus. The arm may be divided into five 
parts, of which two are included in the humerus, two in 
the fore-arm, and one in the hand. The total length of the 
hand is, therefore, one-fifth that of the arm. Double the 
length of the arm (or the two arms stretched out horizon- 
tally), added to the length of the two clavicles, together with 
the transverse diameter of the sternum, is equivalent to the 
whole length of the body. In applying this rule to practice, 
however, we must not forget that the length of the hand, 
and especially that of the fingers, varies materially in 
persons of the same height; and so trifling a variation 
in the third phalanx of the middle finger as the one-thirty- 
second of an inch would, according to this method of calcu- 
lation, figure up as great a difference in the total result, for 
the height of the whole body, as two and a half inches. 

The existence of fractures, deformities and callus in a 
skeleton sometimes affords valuable aid in its identification, 
even many years after death. In relation to the production 
of callus, it is well understood that this substance is the 
result of the reparative inflammation of bones, and that 
its presence on a bone is a certain indication that some time 
must have elapsed between the injury and the death of the 
individual. On the other hand, the total absence of callus 
in a fractured bone, indicating that no time had been given 
for the process of repair, would be very good evidence that 

* Ibid. 



86 MEDICAL JURISPRUDENCE. 

the injury was the immediate precursor of death, and if on 
the skull, the probable cause of death. An instructive illus- 
tration of this is given by Professor Taylor {Med. Jurisp) 
in the case of an Englishman who was tried in India for the 
murder of a native, who had been beaten by the former with 
a stick, with the allegation that his rib had been broken, 
thereby causing his death. To substantiate this charge, a 
skeleton was produced which had been dug up three months 
subsequent to the decease, which was almost completely 
denuded of flesh ; the bones clean and dry ; one rib frac- 
tured, with a deposit of callus around the fracture. The 
identity of these bones with those of the missing man was 
attempted to be established by the prosecution, but unsuc- 
cessfully, in consequence of their dry and denuded state — a 
condition altogether incompatible with so short a period of 
time as three months since death. Moreover, the amount 
of callus thrown out made it evident that more than a week 
must have elapsed before death took place, which event was 
alleged to have occurred immediately after the injury. 

Other notable instances might be mentioned of the iden- 
tification of the skeleton by means of the above-mentioned 
marks, or peculiarities, and even where it was possible to 
determine the actual cause of the violent death. In the 
year 1823, a soldier living in the south of France suddenly 
disappeared, under suspicious circumstances. Two years, 
however, elapsed before any investigation was instituted by 
the proper authorities. Some human bones were then dis- 
covered in digging in the garden of the deceased soldier. 
Of course, it became necessary to identify these remains. It 
was remembered that the deceased had a singular personal 
deformity, in possessing a sixth finger on the right hand, and 
a sixth toe on the left foot. On examination, it was ascer- 
tained that the fifth metacarpal bone of the right hand was 



DURATION OF BONES AFTER BURIAL. 87 

shorter and broader than the corresponding bone of the 
other hand, and further, that there were tzvo articulating sur- 
faces on its digital end, indicating clearly the existence of a 
supernumerary finger. In the same way, the fifth metatarsal 
bone of the left foot showed two distinct articulating faces 
on its digital extremity, indicating the existence of a super- 
numerary toe. Besides this, the age, sex and stature of the 
skeleton corresponded with those of the missing man. But 
even further than this, a close inspection of the skull revealed 
the distinct marks of a depressed and radiated fracture of the 
temporal bone, which showed no sign of reparation by the 
formation of callus. Evidently, then, death had occurred 
very soon after the fracture of the skull, and in all proba- 
bility, as the direct result of violence. Upon this evidence, 
the suspected parties were tried and executed, having pre- 
viously confessed their crime. 

Sometimes, on the exhumation of bones, the medico-legal 
question arises — how long have they been buried ? It is 
quite impossible to give more than an approximative reply 
to this question, after all the soft parts have disappeared, 
which commonly requires about ten years, on an average. 
In a dry soil, bones will resist decomposition for thirty or 
forty years after burial. As this process progresses, they 
become lighter in weight, in consequence of the loss of 
animal matter, and the color externally grows darker. The 
ends gradually become brittle, and crumble away, and finally 
the shaft of the bone undergoes a similar disintegration, the 
mineral matter alone remaining unaltered, and constituting 
the "dust" to which the animal body must eventually be 
reduced. Devergie states that the bones of King Dagobert 
were found in a state of tolerable preservation, enclosed in a 
leaden coffin and sarcophagus, at St. Denis, after the lapse 
of twelve hundred years ; and Dr. Taylor mentions that the 



88 MEDICAL JURISPRUDENCE. 

skeleton of William Rufus was found in a stone coffin at 
Winchester, nearly perfect, after seven hundred and eighty 
years' burial. The bones of Abelard and Heloise were so 
well preserved, that after a lapse of five hundred years the 
female skeleton could readily be distinguished from the 
male. 

Even if the bones have undergone calcination, as when a 
body has been burned with a view of destroying its identity, 
especially in cases of infanticide, it may still be possible to 
determine whether the remains are human, provided the 
bones preserve their proper form, and have not been reduced 
to powder. In the latter case, although a chemical analysis 
of the ash might detect the calcium phosphate, this would 
not solve the mooted question, since the ash of human and 
animal bone is chemically identical. 

Other means of personal identification are afforded by a 
microscopic examination of the liair, and \}i\Q fibres of various 
sorts of fabrics, such as, cotton, linen, wool and silk Human 
hair discovered on a weapon, along with blood stains, affords 
strong presumptive evidence of murder, or violence. So also, 
fibres of cotton, or of other material, found on weapons 
supposed to have caused death, or else on the person of the 
accused, suggest a strong suspicion, if these fibres correspond 
to the clothes of the deceased. Thus, a case is mentioned 
by Prof Taylor, where the discovery of some cotton fibres, 
accompanied by a blood-stain, upon the edge of a razor, 
found near a woman whose throat had been cut while in 
bed, led to the subsequent detection of the murderer. In 
the same manner, the discovery of a few hairs upon the 
handle of a knife, on which also were marks of blood, 
enabled a London microscopist to declare that these hairs 
were squirrel hairs ; which circumstance further led to the 
identification of the murderess of a child, whose throat had 



IDENTIFICATION BY THE HAIR. 89 

been cut with a knife, which, in the death wound, had passed 
through a victorine made of squirrel fur, worn around the 
child's neck. 

In case of rape the examination of the hair about the female 
genitals will be likely to show the presence of seminal spots, 
and consequently of spermatozoa, which cling to them with 
great tenacity. 

In all cases, except when hairs are to be examined 
for spermatozoa, they should be washed in warm water, and 
then thoroughly dried, afterwards steeped in turpentine, and 
finally mounted in Canada balsam. They should then be 
examined with a magnifying power of about 200 diameters. 
To examine hairs for spermatozoa, moisten first of all with 
a drop of ammonia solution, and examine under a micro- 
scope after the liquid has evaporated (Tidy). 

For the identification of hairs, human or other, it is 
desirable to have at hand specimens of various kinds of 
these, properly mounted, for comparison. Hairs resist 
putrefaction for an indefinite length of time, which fact aids 
greatly in their examination for medico-legal purposes. It 
should also be remembered that hair is affected differently 
by different reagents. Strong alkalies dissolve it ; acids 
roughen it ; alcohol causes it to look clearer ; chlorine 
water bleaches, and rots it. 

The size of hairs from different parts of the human body, 
as w^ell as from different individuals, varies considerably ; 
thus, the hairs from the head are- finer than the eyelashes, 
but coarser than the hairs from the arm. There is also 
considerable difference in the size of the hairs of the various 
lower animals. The shape and microscopical appearance 
of human and other hair are figured in some of the larger 
works. 

The main mcdico-lcgal questions connected with the 
5* 



90 MEDICAL JURISPRUDENCE. 

identification of hairs are : (i) Is the hair human, and from 
what part of the body ? (2) Does it correspond with the 
hair of the murderer, or of the victim ? (3) Has its color 
been naturally, or artificially changed ? It should be re- 
membered that gray hair is not unfrequently found on 
comparatively young persons, and that undoubted instances 
have occurred of the sudden bleaching of the hair through 
fright or grief As regards the artificial coloring of the 
hair, it is well known that this is one of the means of 
disguise most commonly adopted by criminals, in order to 
elude detection. 

The common hair dyes for coloring light or red hair black 
or brown, are composed of the salts of lead, silver, or bis- 
muth. Hair thus colored may easily be detected by soaking 
it in nitric acid, which dissolves out the mineral, which may 
then be identified by the appropriate tests. It is more diffi- 
cult to bleach or whiten the hair, than to darken it. This is 
usually effected by first washing it in an alkali, to remove 
the greasy matter, and then soaking it in chlorine water, 
which will lighten its tint in a few hours; but, at the same 
time, it will render it very brittle, and impart its peculiar 
odor to it. 

In all artificially colored hair, the fraud can be detected 
by closely watching the new growth, which will be of a 
different color from the other portions; and also by chemi- 
cal tests. 

The fibres of cotton, linen, wool and silk all present well- 
marked differences, when viewed under the microscope. 
The cotton fibre is in the form of a flattened band, with 
thickened borders, and is spiral, or twisted upon itself 
Linen consists of round fibres, having a firm consistency, 
with jointed transverse markings at unequal distances, 
somewhat resembling those on the India cane, and taper- 



IDENTIFICATION OF FIBRES. 91 

ing to a point. Silk fibre has the appearance of straight, 
well-defined cylinders, ft"ee fi'om all markings, and refi-acting 
light powerfiilly. Wool fibre is irregular, wavy, and of 
unequal thickness. The fibres of hemp resemble those of 
flax (linen), but are coarser ; and when boiled in nitric acid 
they exhibit no spiral streaks, but swell and become brittle. 
The identification of blood stains and seminal spots will be 
treated of later. 



92 MEDICAL JURISPRUDENCE. 



CHAPTER VL 

THE CAUSES PRODUCING VIOLENT DEATH. 
These may be considered under the following heads :- 



L Wounds, INCLUDING Burns. 
II. Suffocation. 

III. Strangulation. 

IV. Hanging. 
V. Drowning. 



VI. Lightning. 
VII. Heat and Cold. 
VIII. Starvation. 
IX. Poisoning. 



section i. 
VIOLENT DEATH FROM WOUNDS. 
DEFINITION OF A WOUND. — DANGER OF. — EXAMINATION OF THE 
BODY. — RESULTS OF THE INJURY. — ABSENCE OF EXTERNAL MARKS 
OF VIOLENCE. — WOUNDS MADE BEFORE AND AFTER DEATH. — 
HEMORRHAGE. — ECCHYMOSES. — CLASSIFICATION. — HOMICIDAL, SUI- 
CIDAL AND ACCIDENTAL WOUNDS. 

The surgical and the legal definition of a wound are not 
identical. The former idea of the term is ''a solution of 
continuity of the soft parts, occasioned by external vio- 
lence." According to this meaning, there must be a rup- 
ture of the skin, or the mucous membrane, to constitute a 
wound. But this would evidently exclude internal injuries, 
such as rupture of the liver, spleen, or heart, fractures and 
luxations unaccompanied by external lesion; hence, the 
/^^^/ definition of a wound is more comprehensive; it em- 
braces all injuries of the body, whether external or internal, 
with or without a solution of continuity of the skin, pro- 
duced suddenly by external, or mechanical violence. The 
latter meaning of the term wound is evidently its proper 
medico-legal application, although it may not strictly accord 
with the surgical definition. 



WOUNDS A CAUSE OF DEATH. 93 

A distinction is sometimes made between mortal and noii- 
niortal wounds, or between wounds dangeroiLS and not dan- 
gerous to life, and the medical witness is asked to give his 
opinion on this subject. But he should be guarded in his 
answer, since it is well known that many wounds at first 
considered as comparatively trivial, subsequently assume a 
dangerous, and even fatal character. Of course, in many 
cases there can be no difficulty in pronouncing upon the 
dangerous of mortal character of a wound, as, for instance, 
if the heart or the great vessels have been wounded, in 
compound fracture of the skull, in wounds of the internal 
viscera, etc. The danger of a wound, it may be remarked, 
depends upon a variety of circumstances, all of which 
should be considered, such as its position; its locality in rela- 
tion to the great vessels and nerves ; the kind of weapon 
by which it was inflicted; the amount of hemorrhage ; the 
age, constitution and general health of the subject ; the cir- 
cumstances (favorable or unfavorable) for treatment, and 
other considerations, all of which must be taken into account 
as important factors in the prognosis. Medical testimony 
is not usually required, except in case of a fatal termination. 
An exception to this may, however, occur in the case of an 
assault, where the character of the injury (whether dangerous 
or trivial) might decide as to the propriety of accepting bail 
for the prisoner. 

In case of death from a wound, the medical examiner 
should never theorize as to the manner of its causing the 
death ; and he should give his opinion only after a very 
careful post-mortem examination of the body. Moreover, 
this examination should not be confined simply to the 
wounded portion of the body, but all the cavities and organs 
should be inspected, since it might be affirmed that a natural 
cause of death might have existed in that very part which 



94 MEDICAL JURISPRUDENCE. 

was neglected by the examiner. Such neglect has often 
been the means of securing the release of the prisoner, inas- 
much as it occasioned a doubt as to the real cause of death, 
in the minds of the jury. It may even be proper to examine 
the stomach for poison in all doubtful cases ; as shown by 
the oft quoted instance related by Wildberg, of the girl who 
was beaten by her father for stealing, and who died shortly 
afterwards, apparently from the effects of the blows, but in 
whose stomach a considerable quanity of arsenic was found. 
She had swallowed the poison soon after committing the 
theft, fearing her father's anger. The man was discharged. 
In a similar manner, it sometimes happens that a person, 
after taking poison with suicidal intent, may destroy himself 
by another means, as by a gunshot wound, by drowning, or 
by throwing himself from a window or a precipice. 

The examination of the wound includes the observation 
of its situation, extent and direction; the presence or absence 
of effused blood, whether liquid or coagulated, and the pres- 
ence of ecchymoses ; the condition of the edges of the 
wound, whether everted or not ; whether adhesion has com- 
menced ; the presence of granulation, inflammation, suppu- 
ration, or gangrene ; whether it was inflicted before, or after 
death ; whether there was loss of substance ; hernia of the 
intestinal organs, etc. There should also be an inspection 
of the clothes of the deceased, to ascertain if the rents or 
stabs in these correspond with the wounds of the body ; and 
if a weapon be discovered, it should be carefully compared 
with the wound. 

It sometimes happens, in cases of severe injury, that 
death has resulted from internal lesions, with few or no 
external marks to indicate them. According to Casper, 
this is of frequent occurrence in severe internal lacerations 
occasioned by violence. He cites a case of this character. 



WOUNDS BEFORE AND AFTER DEATH. 95 

A wagoner, in guiding his team with a loaded wagon down 
a hill, was accidentally crushed against a tree on the road. 
He was found dead the next morning. The only external 
injuries were a slight abrasion upon the left arm, and one 
upon the right temple. On opening the body, however, the 
most striking evidences of violence were discovered. From 
the spinal canal, about a quart of blood escaped. The 
spinous processes of the first thoracic vertebrae were broken 
off. The left pleural cavity contained about thirty ounces 
of fluid blood. The pericardium was torn completely 
across, and the heart, severed from its large vessels, lay 
almost entirely loose in the cavity of the thorax. The open 
ends of the aorta and pulmonary artery were distinctly 
visible. The left lung was entirely torn through its middle 
portion ; and in the right lobe of the liver was a laceration 
two inches long and half an inch deep (GericJit.Med. i, 122). 
The distinction between wounds made before and after 
death should be carefully noticed. Wounds inflicted before 
death may be recognized by the following signs : (i) Incised 
wounds exhibit everted edges, arising from the elasticity of 
the skin and subjacent muscles, with considerable hemor- 
rhage, usually of an arterial character; the spots of arterial 
blood which have spouted on neighboring surfaces are of a 
peculiar comet-like shape. Coagula are more or less 
abundant in the wound, and around it. The surrounding 
tissues are more or less infiltrated with blood. If some 
days have elapsed before death, evidences of vital reaction 
will be shown, such as partial healing, granulation, suppu- 
ration, or sloughing. If the wound was made immediately 
after death — within a few minutes — there may be some 
retraction of the skin, and some slight bleeding, with few 
or no coagula, which are of loose texture. There is little 
or no staining of the surrounding tissues, and never any 



96 MEDICAL JURISPRUDENCE. 

attempt at repair. If the wound be made ten or twelve 
hours after death, there will be no eversion of its edges, no 
hemorrhage, except of a slight venous character, and no 
surrounding infiltration. The experiments of Professor 
Taylor and Mr. Aston Key upon amputated limbs con- 
firm the above description. The amount of hemorrhage 
accompanying an incised wound affords a pretty good 
criterion as to whether it was inflicted before, or after death. 
Comparatively little bleeding accompanies wounds made 
after death, and this is chiefly venous ; the arteries yield 
little or none, while in the living, the hemorrhage is chiefly 
arterial. In a case of murder reported by Casper, as also 
in the case of Greenacre, in England in 1837, where the 
head of the victim was severed from the body, the fact that 
the head was completely drained of blood led to the con- 
clusion that the decapitation had been done during life, and 
that there must then have been a copious hemorrhage to 
account for the absence of the blood after death. 

(2) In lacerated and contused wounds, the distinction is 
not so obvious as in incised wounds. Lacerations are not 
always accompanied by bleeding, but there will always be 
more or less coagula present; and if the person survives a 
few days there will be evidences of vital reaction, such as 
suppuration and granulation, sloughing or gangrene, all 
of which are absent in such wounds inflicted after death. 

Contused wownds made during life are chiefly distinguished 
by the amount of effused blood in the cellular tissue under 
the skin (ecchymosis). This arises from the rupture of 
small vessels, and is manifested by the well-known "black 
and blue " discoloration produced. If the effusion of blood 
is rapid, the spot is of a dark red, at first ; if slower, the 
discoloration is deep blue, or violet. In some cases of even 
violent contusion, there may be no appearance of external 



ECCHYMOSES. 97 

ecchymosis. Again, it is not always manifested immedi- 
ately over the seat of the contusion, but at a little distance 
from it, especially if the surrounding tissue is loose. Familiar 
illustrations of this are afforded in the case of a blow over 
the eye, producing an ecchymosis of the lower lid; and of 
a blow over the lower portion of the abdomen being at- 
tended with ecchymosis of the scrotum. The presence of 
ecchymoses, then, in cases of contused wounds, may be re- 
garded as pretty good evidence of the ante-mortem character 
of the injury, while its absence is not necessarily an indica- 
tion that the wound was post-mortem. The experiments 
of Sir R, Christison upon the dead body go to show that 
if the contusion be made very soon after death, and while 
the body is still warm, the resulting appearances strongly 
resemble those produced by ante-mortem contusion ; with 
this difference, however, that the effusion is usually imme- 
diately beneath the skin, and not in the areolar tissue ; also, 
that there is an absence of coagula, and of swelling. 

Ecchymosis is usually superficial, and may appear very 
shortly after the injury; or it may be deep-seated, and not 
visible at all. In some instances it is not manifested until 
after death, as in the case of a man who died from rupture 
of the bladder, resulting from the kick of a horse, thirty-five 
hours after the injury. No discoloration of the abdomen 
was observed until after his death. Neither can the quan- 
tity of blood effused, nor the extent of the injury be always 
estimated by the amount of the discoloration. This is well 
illustrated in the case of the wagoner who was crushed to 
death, as mentioned by Casper, and which was alluded to 
above. 

Another important fact relative to ecchymoses is the 
chajige of color which accompanies them, since this may 
serve to indicate the probable date of the contusion. In 



98 MEDICAL JURISPRUDENCE. 

about twenty-four hours the blue or hvid margin of the 
bruise becomes hghter, or of a violet color, which gradually 
changes to green and yellow. During these alterations of 
color, the spot may become larger, but the central portion 
remains always darker than the margins. These changes 
of color are believed to be due to a dilution of the serum 
of the blood by the fluid of the cellular membrane, and its 
gradual dispersion throughout the cells. It is finally ab- 
sorbed, and the color entirely disappears. In general, it 
shows itself within twelve hours after the contusion ; the 
violet color within three days ; the green from the fifth to 
sixth day; the yellow from the eighth to tenth day; and in 
healthy persons, the complete disappearance of the spot 
occurs from the twelfth to fourteenth day. The changes 
are more rapid in the young than in the old, and depend 
also on the degree of the contusion. The above changes of 
color never appear in contusions on the dead, which cir- 
cumstance constitutes another diagnostic mark. 

It is also important not to mistake the ecchymosis pro- 
ceeding from natural causes, such as scurvy, petechise 
and purpura, from that occasioned by blows. The former 
may usually be distinguished by being confined to the 
superficial layers of the skin, and by their presence also on 
the internal mucous membranes, together with the absence 
of swelling, and the fluidity of the blood. 

According to Devergie, ecchymoses are often concealed 
on the bodies of the drowned, when first they are removed 
from the water, owing to the sodden state of the skin ; they 
may become apparent only after the body has been exposed 
for some days, and the water has evaporated. 

(3) In punctured and penetrating wounds^ the diagnosis 
between those inflicted before, and those produced after 
death, is usually not difficult. The former are attended with 



INCISED WOUNDS. 99 

more or less hemorrhage, and often exhibit signs of vital 
and reparative reaction, such as inflammation and suppura- 
tion, or gangrene. The latter are destitute of all these. 
For example, a stab made into the left ventricle of the heart 
after death is followed by no hemorrhage. 

It is not always possible for a medical witness to state 
positively that a wound was caused by a particular iveapon ; 
but it is desirable, if possible, to establish the relation of the 
injury with its supposed cause ; thus, an i7tcised vjound would 
naturally be referred to a cutting weapon ; a penetrating 
wound to a pointed one ; and a contused wound to a blunt 
instrument. But caution should be observed in giving an 
opinion on this subject, especially in case of contused 
wounds. 

Incised wounds are characterized by the regularity and 
evenness of the cut. This usually serves to distinguish 
them from wounds made by glass and crockery ware, or 
nails, which are generally irregular and uneven. But in 
some instances, the cuts produced by broken glass or china 
exactly resemble incised wounds. In stabs^ the shape of 
the wound may often indicate the character of the weapon, 
whether double-edged or not. But where the weapon has 
penetrated obliquely through the tissues, and when these 
have been stretched, the shape of the wound will not exhibit 
this correspondence. So also, a wound made in parts where 
the skin is wrinkled may suggest the idea of several distinct 
wounds, as in the neck. It must not be overlooked that 
superficial incised wounds may give rise to dangerous, or 
even fatal hemorrhage. And also, that it is not always pos- 
sible, in such cases, to determine the direction of the incision, 
i. e., whether made from right to left, or the reverse. And 
yet, as remarked by Casper, this fact might have a most 
important medico-legal significance in determining the ques- 



100 MEDICAL JURISPRUDENCE. 

tion whether the wound, as in cutting the throat, was homi- 
cidal or self-inflicted. The attendant circumstances, however, 
might throw some light upon it, such as the presence of 
blood on the right or left hand, or cuts on certain parts of 
the clothing of the deceased. 

Lacerated and contused wounds do not afford the same 
facility for identifying the weapon as incised wounds. From 
simply inspecting them, the medical witness will not gener- 
ally be able to indicate the precise weapon, or cause. He 
may, indeed, be able to say that it was not produced by a 
cutting instrument. But a blow made by a blunt weapon 
upon the skull, or over the zygoma, may give rise to a cut 
which strongly resembles an incised wound, though, as a 
rule, the division of the parts is not as straight and regular 
as in the latter, and the angles of the wound are less acute. 
Moreover, in the contused wounds there is more or less 
swelling, and extravasation of blood into the adjoining 
parts ; and, at times, the existence of irregular fracture and 
internal hemorrhage. 

In the case of a fatal contused wound of the head, it has 
been judicially decided that it makes no difference as to the 
guilt of the accused, whether he produced the death of his 
victim by a direct blow upon the head, or indirectly, by 
causing him to fall upon a stone, or other hard substance, 
which produced the fracture, or contusion. 

As before mentioned, rupture of the internal organs — the 
liver, spleen, heart, lungs and kidneys — is a frequent result 
of contusions. Fracture of the base of the skull is some- 
times caused by severe contusion of the head. Wharton 
and Stille {Med. Jurisp., Book V, p. 660) allude to the fact 
that spontaneous wounds sometimes occur in the labia and 
vagina of pregnant women, which might give rise to suspi- 
cion of assault. Also, that in such women accidents of 



EXAMINATION OF THE CLOTHES. 101 

different kinds are frequently attended with profuse hemor- 
rhage from the pudenda. 

It is evident from what has been said in reference to the 
difficulty of always connecting a contused wound with the 
precise instrument that caused it, that the witness should 
avoid committing himself upon the question. In some 
instances, however, the shape of the contused wound, espe- 
cially a depressed fracture of the skull, will enable us to 
come to a correct conclusion on the subject. Some years 
ago the author was called upon, as an expert, to testify as to 
the probable cause of a depressed fracture of the temporal 
bone of a man who had been struck during a melee. The 
question was, whether the injury had been inflicted by the 
fist merely (as was alleged), or by an instrument like a 
loaded cane, or billy. There was good reason for believing 
that the latter instrument, in the hands of another person, 
was the real cause of his death, owing to the private con- 
fession of a comrade of the prisoner. The fractured bone 
was produced in court. The depression was well-marked, 
a quarter of an inch deep, exactly corresponding to the 
loaded end of the billy ; no radiating fissures (as would 
most probably have resulted from a blow of the fist). 
Although the opinion of the author, founded on the above 
facts, was, that the fatal blow had not been inflicted by a 
fist, but by a billy, two physicians on the other side thought 
differently; and the judge dexterously solved the mooted 
question by asserting that, in such cases, one expert was 
about as good as another ; and inasmuch as, in the present 
trial there were two against one, he would decide in favor of 
the majority! and so he did, and the prisoner (possibly an 
innocent man) was convicted, and sent to the penitentiary 
for five years. 

The examination of the clothes of the deceased constitutes 



102 MEDICAL JURISPRUDENCE. 

an important part of the legal physician's duty, as this may 
throw light upon the mode in which the wound had been 
made, from the character of the cuts, or stabs observed upon 
them. So likewise, marks of blood, dirt, grass, or other 
substances, on the clothing may afford valuable indications 
in the same direction. Contused wounds by bludgeons 
may, however, occasion considerable laceration of the 
muscles, or even severe fractures, without tearing the dress. 
Professor Taylor [Med. Jurisp) mentions an instructive 
case, showing the importance of comparing the articles of 
dress with the injuries which may have proved fatal. A 
woman, aged sixty, was found one morning dead in her bed. 
She had been seen in her usual health on the previous 
night. On inspection, there were found two indentations in 
the right parietal bone, and a large clot of blood in this 
situation, beneath the skin, together with a fracture of the 
bone, four inches in extent. Beneath the bone, on the dura 
mater, were found nearly three ounces of clotted blood. 
On the evening before her death, she had been suddenly 
knocked down on the public road, by a man accidentally 
running against her. She fell heavily on the back of her 
head, appeared stunned, was raised upon her feet, and, after 
swallowing some brandy, recovered sufficiently to walk 
home, a mile and a half, and eat her supper. She was 
found next morning dead in bed. There was a suspicion of 
murder, in this case, against a fellow lodger ; but when the 
bonnet worn by the woman was produced at the inquest, 
two indentations were discovered on the back part of it, 
corresponding to those on the skull of the deceased. The 
indentations on the bonnet, moreover, contained dust and 
dirt, thereby confirming the statement of witnesses who had 
seen her fall, and rendering it highly probable that this fall 
was the real cause of the fatal fracture, and effusion of blood. 



NATURE AND EXTENT OF THE WOUND. 103 

It also illustrates the well-known fact that a person may 
receive a fracture of the skull ending in effusion, which may 
not prove fatal for many hours after the accident, and which 
may not have prevented the individual from walking a con- 
siderable distance after the injury. 

Was the wound homicidal, suicidal, or accidental ? This 
important medico-legal question cannot always be settled 
by medical testimony alone, though there are many points 
in which it is of the greatest aid to the legal authorities. 
These are as follows : — 

1. The Situation of the Wo?md. — Sidcidal wounds are 
usually inflicted upon the most accessible parts of the body, 
such as the head, neck, breast and abdomen. If by fire- 
arms, the part usually selected is the head (mouth, forehead 
or temple); or over the heart ; if by a cutting instrument, the 
throat or heart. The discovery, therefore, of wounds on a 
part of the body difficult to reach by the individual himself, 
as the back, would certainly not be suggestive of suicide. 
But an exception must be made here as regards the insane, 
who are well known to destroy themselves by self-inflicted 
wounds of the most extraordinary character, on the back of 
the head and neck ; by striking the head against some solid 
substance ; or precipitating themselves from a height. An 
insane person has been known to shoot himself with a pistol 
fired from behind the ear. The situation of the wound is, 
therefore, only suggestive of its origin, since it is quite pos- 
sible that an assassin might inflict a death wound upon his 
victim in such a situation designedly, in order to deceive, 
and thus elude the suspicion of homicide. Accidental 
wounds are usually met with on exposed parts of the body. 

2. Nature and Extent of the Wound. — Suicide is rarely 
inflicted by contused wounds, but usually by incised or 



104 MEDICAL JURISPRUDENCE. 

penetrating ones. Exceptions occur, as when a person 
throws himself out of a window, or from a height; and in 
some remarkable instances of self-destruction, by butting 
the head against a wall, and subsequently chopping it with 
a hatchet. In the case of the insane, there is no accounting 
for the variety in the nature, and extent of the wounds in- 
flicted for the purpose of self-destruction. This fact ought 
to be remembered, since, if the bodies of such persons 
should afterward be discovered, and nothing be known of 
their previous histories, serious errors in relation to the real 
origin of the wounds might result. 

Incised Wounds of the Throat are usually regarded as in- 
dicating suicide; but it is well-known that murderers fre- 
quently destroy their victims by cutting their throats. As 
to the extent of the wound, it is commonly supposed that a 
suicidal incision of the throat does not reach as deeply as a 
homicidal one of the same character; but instances are not 
wanting where a determined suicide has severed the throat 
down to the vertebrae. Again, irregularity in the cut of the 
throat has been deemed by some as indicating homicide 
rather than suicide, under the idea of resistance on the part 
of the victim ; but it is evident that the irregularity might 
have resulted equally from nervousness, or indecision in 
inflicting the wound, on the part of the deceased. 

The nature and extent of the wound or injury may serve 
to distinguish accident from Jioniicide. Thus, if numerous 
wounds or bruises are discovered in opposite sides of a 
dead body, the presumption would be in favor of homicide; 
and when the accused attempts to ascribe the death of his 
victim to a fall, the nature of the wounds might be such as 
positively to contradict his assertions. 

3. Direction of the Wound. — This will often enable us to 
distinguish between a homicidal and an accidental wound. 



WOUNDS OF THE THROAT. 105 

rather than to decide upon its suicidal character. Thus, if 
death has occurred from a stab, inflicted downzvard from 
the upper part of the thorax, and penetrating the heart, 
and it was attempted on the part of the prisoner to show 
that the wound had been accidentally occasioned by the 
deceased falling, while drunk, downward upon the knife 
which the prisoner had held in his hand sloping iipivard, 
the direction of the wound would prove the falsity of the 
statement. Two other cases are here quoted from Wharton 
and Stille's Med. Jurisp.^ of a similar character. One of a 
man discovered dead, with a deeply-punctured wound of 
the neck, which, on examination, showed that the weapon 
had been partially turned and withdrawn, and again plunged 
into the neck in a different direction, after the manner of 
the German butchers. This circumstance proved not only 
that the death was not accidental, nor probably suicidal, 
but indicated the occupation of the murderer. The other 
occurred in England, some years since, where a murder 
was fixed upon a man from the fact that the wound in the 
neck of the deceased had been evidently made by a knife 
cutting from within outward, as is done in slaughtering 
sheep. 

In most suicidal wounds of the throat, it is found that the 
cut has been made from left to right ; in punctured wounds 
the direction is commonly from right to left, and downward. 
In left-handed persons, the direction would, of course, be 
the reverse. These facts, however, can only afford moderate 
presumptive evidence, since it is obvious that a murderer 
might inflict an incised wound in the throat of his victim 
from behind, which would exactly resemble that made by 
the suicide. In all such doubtful cases, particular attention 
should be directed to the surrounding circumstances, such 
as the position of the body, and the weapon, the presence 
6 



106 MEDICAL JURISPRUDENCE. 

or absence of blood upon the hands and person of the 
deceased, etc. If the death has been very sudden, from 
hemorrhage (in a case of suicide), the weapon will most 
probably have fallen from the hand, on account of the 
relaxation of the muscles ; but if it has been caused by a 
pistol, the weapon may be found tightly grasped in the 
hand of the deceased. If the throat has been cut suicidally, 
blood will be found on one or other of the hands ; but if 
homicidally, and no resistance has been made, the hands 
will probably be unstained. As regards the position of the 
body, if the death be very sudden, from loss of blood, the 
body will be found lying on the back ; if less sudden, the 
face and trunk will be turned toward the ground. If the 
body be found upon the back, in death from hemorrhage, 
and the weapon at a distance from it, the act was, in all 
probability, homicidal. 

The position of the weapon in relation to the dead body, 
although at times strongly suggestive, can never afford 
absolute evidence as regards the question of homicide or 
suicide. Thus, Professor Casper mentions the case of a 
man who cut his throat with a razor, which was found, 
bloody, and closed, two feet distant from the body. Also, of 
another suicide by a pistol-shot in the breast, where the 
pistol was found in the pocket of the deceased, who after-- 
wards terminated his life by drowning himself (Gericht. 
p. 17). 

From what has been said above, it is manifest that the 
medical jurist can rarely venture to give a positive opinion 
as to the homicidal, suicidal, or accidental cause of death, 
apart from a consideration of the circumstances accompany- 
ing it. These circumstances constantly vary in almost every 
case, and they require the utmost experience and tact on 
the part of the medical examiner to recognize and apply 



GUNSHOT WOUNDS. 107 

them in each individual instance. Some of them have 
ah-eady been alluded to : they include the position of the 
body and the weapon; the condition of the ground where 
the wound was inflicted ; the presence of footprints, of man 
or horse; the condition of the clothing of the deceased; the 
condition of the hands, whether showing wounds, or cuts on 
their palms (indicating resistance), or the hands holding 
portions of hair or fragments of the assailant's clothes ; the 
adherence of certain fibres to a weapon, such as cotton, 
woolen, linen, silk or fur ; marks of blood upon clothing or 
furniture ; state of the mouth and throat ; marks of blood 
or other matters on the person of the assailant; rifling of 
the pockets, and tearing of the dress, etc. These cannot be 
farther enlarged upon here, but their medico-legal import- 
ance cannot be too strongly insisted upon. 

SECTION II. 

GUNSHOT WOUNDS. 

DIFFER FROM OTHER WOUNDS. — DEFLECTION OF THE BALL. — WOUNDS 
MADE BY SHOT, WADDING AND POWDER. — CAUSE OF DEATH IN 
WOUNDS. — WOUNDS OF THE HEAD, NECK, SPINE, CHEST, ABDOMEN. 

Gunshot wounds differ from other wounds chiefly in the 
fact that the vitality of the part struck is lost, and that there 
is a consequent slough, or loss of substance. They are 
essentially contusions. They are dangerous to life on ac- 
count of their involving vital portions of the body, death 
occurring either from hemorrhage, or from shock to the 
nervous system. The hemorrhage is seldom great, except 
when large vessels are wounded. Often, from the form of 
the wound, there may be but little external bleeding, while 
a fatal internal hemorrhage may be going on. They differ 
much in appearance, according to the distance from which 
the piece was fired, and the nature of the projectiles. If the 



108 MEDICAL JURISPRUDENCE. 

explosion occurs in close contact with the body, the wound 
is large and circular, the skin denuded, blackened and 
burned by the half consumed grains of powder. The hair 
and clothes also in the vicinity of the wound are more or 
less scorched. The entrance orifice of the ball is livid and 
depressed, and is larger than the point of exit. When the 
piece is fired from a distance, the blackened and burned ap- 
pearance of the skin is not seen, but only the mark of the 
entrance of the missile, and sometimes that of the exit. 
The aperture of entrance of the ball when fired from a 
distance is, according to most authorities, always smaller 
than that of exit. Nelaton says that when the wound is 
recent, the entrance orifice is depressed and contused, while 
the exit aperture is lacerated and everted. In the former, 
there is an actual loss of substance; in the latter, there is 
merely a solution of continuity. After some days, however, 
the contused margins of the entrance wound slough away, 
thereby enlarging the orifice, while those of the exit par- 
tially adhere, causing the latter wound to appear smaller 
than the former. Professor Casper declares that the en- 
trance aperture is always the larger. Very possibly, this 
discrepancy of views may arise from not distinguishing be- 
tween the early and the later stages of the two orifices. If 
the ball enters a very fat portion of the body, this often 
protrudes between the edges of the wound, and completely 
changes its appearance. Again, the character of the en- 
trance will depend very much upon the nature of the pro- 
jectile, and its velocity, as well as the distance from which 
it was fired. If the ball is conoidal, as in the minie rifle, 
and traveling with great speed, the wound is linear, and 
resembles a puncture, producing little external harm, but 
causing very considerable internal injury. A rifle ball 
makes a large and ragged wound, caused by the spiral 



WOUNDS BY SHOT. 109 

direction given to the missile. It is evident that several 
wounds may be made by a single ball, as this may chance 
to traverse different parts of the body and limbs. It may 
also happen that the piece may have been loaded with two 
or more balls, which may account for the number of the 
wounds. 

The deflection of a ball from its straight, or direct course 
after entering the body is easily produced by its striking 
obliquely against any resisting surface, such as a bone, 
tendon, aponeurosis, or even muscle. In this way it often 
happens that a ball, striking the chest or abdomen, may be 
caused to pass almost entirely around the body, and after- 
wards be extracted close by the entrance point. Wharton 
and Stille (Med. Jw^isp) relate the case of a German student 
who was wounded in a duel by a pistol ball striking him on 
the larynx obliquely, and passing around the neck so as to 
lodge on the opposite side of the thyroid cartilage. It was 
thence removed by simply cutting through the skin. It is 
not uncommon for a ball to travel half way around the chest 
or abdomen, and lodge in the back, giving the appearance of 
having passed directly through the lungs, or intestines. 

If the wound be caused by a load of shot, its appearance will 
depend chiefly on the distance from which it was discharged. 
If fired very near the body, so as to enter it as a single 
charge before separating, it will produce a single large 
and ragged wound, much contused and blackened by the 
powder ; and as the shot diverge after entering the body, 
there will be considerable laceration of the parts beneath. 
For the opening to be single, the experiments of Dr. 
Lachese, of Antwerp, have shown that the charge should 
not be fired at a greater distance than ten to twelve inches. 
When the distance is so extended as to allow the scattering 
of the shot, each grain will make its own individual wound. 



110 MEDICAL JURISPRUDENCE. 

It is quite possible for a single shot to cause a mortal wound, 
as when it happens to strike the heart, or aorta. 

Wounds made by the wadding and gunpowder alone may 
prove serious or fatal, according to the distance of the piece 
from the body. A pistol thus loaded, at twelve inches 
distance tore the clothes, and abraded the skin without 
penetrating it; at half this distance, the wadding penetrated 
to the depth of half an inch ; at two inches it entered to 
the depth of two inches, causing a ragged and blackened 
wound ; and at one and a half inches, the wadding entered 
the thorax between the ribs, and in one experiment, carried 
away a portion of the rib (Phil. Med. Exam., 1846). Taylor 
mentions an instance of a man sitting in a gallery of a 
theatre at Brighton, in 1881, who had the upper half of his 
hand completely blown away by a piece of greased news- 
paper, tightly rammed, discharged from a small cannon on 
the stage of the theatre. 

Even gunpowder alone is capable of producing very 
serious wounds, if fired close to an exposed part of the 
body. The wound will present a lacerated appearance, and 
be blackened and burned by the partially consumed powder. 
If the grains of powder be coarse, the wound may have the 
appearance of having been caused by very small shot. 

The question of the homicidal, suicidal, or accidental char- 
acter of gunshot wounds must generally be settled by the 
appearance of the wounds, and also by the surrounding 
circumstances. Thus, if it be on the forehead or temple, in 
the mouth or over the heart, and if it be blackened and 
lacerated (indicating the close proximity of the weapon), it 
may be regarded as a suicidal act. If, on the contrary, the 
wound be on the back, or side of the head (except in the 



1 



CAUSE OF DEATH FROM WOUNDS. Ill' 

case of the insane), or of the body, without the blackened 
and lacerated appearance above alluded to, it may be con- 
sidered as the act of a homicide. Accidental gunshot 
wounds bear the marks of near wounds, as they are mostly 
the result of the accidental discharge of the piece, either in 
the hands of the deceased at the time, or else in close prox- 
imity to his person. 

Out of 368 cases of suicide by firearms, 297 were from 
wounds in the head; of these, 234 were fired into the mouth; 
only 71 were from wounds inflicted on the chest or abdo- 
men (M. de Boismont, Du Suicide, p. 531). 

Cause of Death from Wounds. — In a medico-legil 
case it may become important to ascertain the real cause of 
death occasioned by a wound — whether immediate, as from 
hemorrhage or shock, or remote, resulting from subsequent 
complications. In a trial for murder, this question might 
have an important bearing on the result. 

When the death is directly traceable to hemorrhage, its 
rapidity depends upon the amount and suddenness of the 
bleeding; and this again is dependent on the size and 
nature of the vessel wounded. Exhaustion follows much 
more rapidly from a sudden hemorrhage than from a more 
copious flow of blood if gradually lost. Again, arterial 
hemorrhage is more rapidly fatal than venous. It should 
also be remembered that some persons have a constitutional 
tendency to bleed very easily, from the slightest superficial 
wound. Such a tendency is termed a hemorrJiagic diathesis; 
this is sometimes hereditary; and where it exists, it exposes 
the individual to great danger, in case of being wounded. 
Age and disease also increase the danger of death by hem- 
orrhage from wounds. 

Internal hemorrhage, as the result of a wound, is often as 



112 MEDICAL JURISPRUDENXE. 

Yatal as the external ; the danger is here further increased 
by the pressure exerted by the effused blood upon a vital 
organ, such as the brain, as is witnessed in effusion of blood 
within the cranium, produced by a fracture of the skull. 
It is also exemplified in a wound of the intercostal arteries, 
causing effusion of blood into the chest, and producing fatal 
pressure on the lungs ; and also in wounds of the throat 
resulting in asphyxia, from the flow of the blood into the 
windpipe. 

Shock is the result of a violent impression made on the 
great nervous centres. It often is the immediate cause of 
death, after a severe injury, without leaving behind any 
trace or lesion discoverable on a post-mortem examination. 
Shock is most apt to follow extensive lacerations of the 
body, such as result from machinery or railway accidents, 
or from extensive burns. 

The remote causes of death from wounds are numerous 
and varied. The following may be regarded as the most 
common : — 

1. Tetanus or lockjaw. — This is generally the result of 
lacerated and punctured wounds, and especially if inflicted 
on nerves, tendons, aponeuroses and fibrous tissues. Avery 
slight wound in these structures may be followed by fatal 
tetanus. Tetanus is always a very serious complication, 
and is mostly fatal. It does not usually appear before the 
seventh day after the receipt of the wound, though some- 
times earlier; and it rarely supervenes after the twentieth 
day. 

2. Erysipelas is another complication of w^ounds, which 
may give to them a fatal issue. It is particularly apt to 
accompany wounds of the scalp ; and it sometimes assumes 
an epidemic character, especially in hospitals, where it may 
occasion great mortality among the wounded patients. 



DEATH FROM SURGICAL INTERFERENCE. 113 

3. Hospital gangrene is another occasional result of 
wounds. It likewise often proves fatal, and may assume an 
epidemic type. It is, however, rarely seen, except in mili- 
tary hospitals, and seems to be connected with faulty 
hygienic arrangements. 

4. Surgical interference^ including the Use of AncestJietics. — 
In wounds dangerous to life, the question of the propriety 
of a surgical operation becomes paramount; the patient will 
certainly die without the operation, and, on the other hand, 
he may die from shock, as the immediate result of the 
operation. The question of the legal responsibility of the 
death then becomes a serious one, and in the event of a 
trial, the counsel for the prisoner, who had originally in- 
flicted the wound, will endeavor to show that the death was 
not really the result of the wound, but was rather owing to 
the surgical operation. Whatever plausibility there may be 
in such an argument, it would not likely avail with an intel- 
ligent court and jury, unless it could be proved that the 
original wound was 7iot of a dangerous character; and, 
secondly, that the surgical interference was unwarrantable, 
and unskillfully employed. The same remarks will apply 
to the use of anaesthetics (ether and chloroform) in the per- 
formance of surgical operations. Their employment in such 
cases has now become so universal throughout the civilized 
world, that the occasional fatal results attending their admin- 
istration should be regarded as exceptions to the universal 
rule of safety accompanying their employment, and as in no 
wise inculpating the attending surgeon ; consequently, the 
fatal result that might happen to follow their use should not 
be considered as offering any extenuation for the prisoner, if 
the latter has inflicted a dangerous or fatal wound upon the 
deceased. The only medico-legal point at issue would be — 
was the administration of the anaesthetic a necessary and 

6* 



114 MEDICAL JURISPRUDENCE. 

proper part of the treatment, and was it skillfully adminis- 
tered ? 

It will be proper to devote a brief consideration to the 
subject of Wounds in different regions of the body, inasmuch 
as these present certain individual peculiarities, which give 
to them special medico-legal importance. 

Wounds of the head. — Scalp wounds are not usually at- 
tended with danger, except sometimes, when followed by 
erysipelas, and when the blow has been so severe as to 
produce concussion of the brain. It must not be forgotten 
that fracture of the skull may exist without any wound of 
the scalp ; also that fatal effusion of blood upon the brain 
may be produced by a blow on the head, without causing 
either a wound of the scalp, or a fracture of the skull. 

CojicKssion of the brain may result either from a direct 
blow upon the head, or from a violent fall upon the feet 
or buttocks. Sometimes death ensues immediately from 
concussion, leaving behind it no perceptible lesion, though, 
doubtless, some molecular change has been caused in the 
nerve cells, not recognizable by the microscope. Such fatal 
concussion may occur without either fracture of the skull, 
or even a wound of the scalp. The symptoms of concussion 
are faintness, nausea and vomiting, pallor of face, feeble 
pulse, loss of consciousness, either partial or complete, with 
subsequent confusion of ideas, and tendency to sleep. Con- 
cussion may be confounded with intoxication, compression 
of the brain, opium poisoning, sunstroke, etc. 

It is particularly important, for medico-legal reasons, to 
distinguish between concussion and intoxication. Doubtless, 
many cases of supposed drunkards, arrested in large cities at 
night by the police, and left unattended in the station house till 
morning, are, in reality, cases of concussion, or compression 
of the brain, which may prove fatal, simply for want of 



COMPRESSION OF THE BRAIN. 115 

timely relief. What adds greatly to the difficulty of the 
diagnosis is the fact that the two conditions are so frequently 
coincident in the same individual. It is the drunken man 
who is most apt to engage in a brawl which results in a 
broken head. Generally, the history of the case (if it can 
be obtained), and the odor of the breath, will afford us the 
best means of diagnosis. In intoxication, the temperature 
is usually below 96° F. — sometimes below 90° ; the loss of 
power and of sensation are not unilateral, as in compression ; 
the bladder is generally full of limpid urine, which will 
furnish evidence of the presence of alcohol on distillation. 
( Vid. A'LCOHOL, post.) The pupils are sometimes contracted, 
and again dilated. 

Fractiu^e of the skull is the result either of a direct blow 
upon the head, or of a fall upon the head, striking a stone, 
or other hard body. The usual consequence of such a 
fracture is pressure on the brain by the depressed bone, or 
by the extravasated blood from a ruptured vessel, or vessels. 
Fracture of the base of iJie skull \?> the most dangerous of all. 
It is nearly always fatal ; and unless carefully looked for in 
the autopsy, it may entirely escape notice. 

Compression of the brain may result either from effusion 
of blood or serum upon, or within the brain, with or without 
fracture, or depression of the bone; also from suppuration, 
or tumors in the brain, from congestion of the cerebral 
vessels, and likewise from narcotic poisoning. The symp- 
toms are essentially those of apoplexy, viz.: loss of con- 
sciousness, paralysis (usually hemiplegia),' dilated pupils 
(except where the effusion is on the pons Varolii, when, 
according to Dr. Wilks, the pupils are contracted), stertor- 
ous breathing, a full, slow pulse, and coma. It is important 
to remember that the effusion of blood resulting from a 
blow may be very gradual, so that the person seemingly 



116 MEDICAL JURISPRUDENCE. 

recovers from the first shock, and may be able even to 
resume his ordinary occupation for some hours, or even 
days, before the fatal termination takes place. The distinc- 
tion between the effusion from violence, and that resulting 
from disease, as a rule, is that in the former the extravasa- 
tion is nearly always between the skull and dura mater, or 
between this membrane and the brain, while in the latter it 
is usually in the brain substance. Moreover, in the first, 
there is frequently a fracture of the bone, and ecchymosis 
of the scalp, either immediately over the effusion or on the 
opposite side of the head (contrc coup). 

Another important medico-legal point is, that a fatal effu- 
sion of blood may take place simply from great excitement, 
in a quarrel, especially if accompanied by intoxication. 
In a trial for homicide this is likely to be urged by the 
defence as the probable cause of death in the deceased, 
where there has been an assault or pugilistic encounter, 
which terminates fatally. In a case of this nature it might 
be extremely difficult to decide how far the fatal effusion 
was due to natural causes, such as atheroma of the cerebral 
arteries (which, in an habitual spirit-drinker, might also be 
connected with a diseased liver and kidneys), or how far it 
was to be attributable to the effects of violence. We are, 
however, of the opinion that, if the assault could be clearly 
proven, either in connection with a direct blow upon the 
head, or indirectly, by a fall upon a stone or other hard 
body, the mere fact of the preexisting disease of the arteries, 
or the other organs, would not exculpate the prisoner, nor 
acquit him of the charge of homicide. If, however, the 
autopsy shows that the effused clot, or serum, were of older 
date than the alleged injury, this would certainly be a strong 
argument for his acquittal. 

Wo2tnds of the Substance of the Brain are not always fatal. 



WOUNDS OF THE SPINE. 117 

As regards the symptoms of injury to the different portions of 
this organ, as indicating the localization of its various func- 
tions, the reader must be referred to the writers on this 
special department of science. It is well known that con- 
siderable portions of the cerebral substance have escaped 
through the skull, after fractures, not only without loss of 
life, but without any sensible impairment of the mental 
powers. 

Wounds of the Face are not usually dangerous unless they 
involve the orbit ; a penetrating wound of this part may 
readily reach the brain, with a fatal result. So also, a 
severe blow upon the nose may so injure the ethmoid bone 
as subsequently to involve the brain. 

Wounds of the Neck are attended with much danger, 
owing to the presence of the large vessels and nerves. In 
cut throats, the great danger arises from the sudden and 
profuse hemorrhage. The section of the larynx and trachea 
is not necessarily fatal, the chief danger arising from suffo- 
cation from the flowing back of the blood. A division of 
the (esophagus is almost necessarily fatal, chiefly because of 
its involving the section of the great vessels of the neck. 

Wounds of the Spine are dangerous in proportion to the 
degree that the spinal marrow is involved. In concussion 
of the spine, death sometimes takes place instantly. If the 
spinal cord be wounded high up, above the region of the 
phrenic nerve, the function of respiration is immediately 
arrested, and death ensues. Wherever the injury occurs to 
the spinal cord, it is understood that there is a complete 
suspension of the functions of the parts below. In fracture 
of the vertebrce, the great danger arises from pressure on the 
spinal marrow. Sudden death has been produced by the 
spontaneous luxation of the second cervical vertebra, aris- 
ing from the fracture of the odontoid process, through dis- 



118 MEDICAL JURISPRUDENCE. 

ease. Sir A. Cooper's case was of this character (Frac. and 
Disloc. p. 463). These fractures are justly considered as 
having an important medico-legal bearing. 

Wounds of the Chest. — The great danger here lies in the 
hemorrhage from the heart, great vessels and lungs ; hence, 
such wounds often prove rapidly fatal. The hemorrhage in 
wounds of the chest is nearly always internal. Wounds of 
the lungs, though they may not prove immediately fatal, 
frequently so terminate after a lapse of time; this is especially 
true of gunshot wounds, if the bullet or other foreign sub- 
stance happens to be retained. Wotmds of the Heart nearly 
always terminate fatally and rapidly, if the cavities be pene- 
trated. Gunshot wounds of the heart do not necessarily 
cause immediate death ; cases are recorded where the 
patient survived several months ; after death the ball has 
been found in the substance of the organ. Even where the 
cavities of the heart have been perforated by a cutting 
instrument, there have been instances where the person sur- 
vived for eleven days (Wharton and Stille, Med. Jurisp. p. 
745). Rtipture of the heart may be the result of a violent 
blow upon the thorax, or it may follow any intense excite- 
ment or emotion, if this organ happens to be in a diseased 
condition, as in fatty degeneration, etc. In a medico-legal 
case, where death has resulted from this cause in a brawl, 
in which the deceased received a severe blow on the chest, 
if the pre-existing disease of the organ can be established, 
it would be a question how far the violence, and how far the 
disease was to be credited with the result. The case is very 
similar to the one where death follows a blow upon the head, 
terminating in compression of the brain, and where a dis- 
eased condition of the cerebral vessels existed. 

Wounds of the Abdomen. — Even a superficial wound of 
the abdomen may prove fatal, by dividing the epigastric 



WOUNDS OF THE GENITAL ORGANS. 119 

artery. A severe blow upon the epigastric region has fre- 
quently produced immediate death, from shock upon the 
solar plexus of nerves. Blows upon any part of the abdo- 
men may be followed by peritoneal inflammation, which 
often proves fatal. Penetrating wounds may terminate 
fatally from the same cause. Wounds of the stomach and 
intestines are exceedingly dangerous, and are often mortal, 
either from hemorrhage, or from inflammation, or both. 

Wounds of the Liver are dangerous, according to their 
extent and depth. If the gall-bladder is involved, death is 
apt to ensue, in consequence of the peritonitis. The danger 
from wounds of the kidneys arises from the effusion of urine, 
and the consequent inflammation. 

In relation to zvounds of the bladder^ it should be remem- 
bered that this organ may be ruptured spontaneously, from 
over-distention. It is sometimes ruptured by a blow, or 
kick of a horse, upon the lower part of the abdomen. In 
a trial for homicide, in a case of death produced by rupture 
of the bladder, the defence would probably try to set up the 
plea of spontaneous rupture of this organ. Frequently, 
there is no external injury to indicate the true nature of the 
case, the autopsy alone revealing it, and disclosing, also, 
extensive peritoneal inflammation, resulting from the escape 
of urine. 

Wounds of the Genital Organs are, in the male, usually 
self-inflicted, and they are met with most generally among 
the insane. They comprise castration — more or less com- 
plete, and amputation of the penis — partial or entire. The 
danger to life is great in proportion to the hemorrhage, and 
injury to the organs. In certain other cases, where the in- 
jury has been inflicted by others, and when in a state of erec- 
tion, the urethra has been found violently torn across, and 



120 MEDICAL JURISPRUDENCE. 

the corpora cavernosa and spongiosa divided. In females, 
the chief point of medico-legal interest is to discriminate 
between wounds of the genitals inflicted by another, and 
spontaneous hemorrhages from a ruptured vein in the labia. 
Here, of course, a rigid inspection of the injured parts will 
be required before arriving at a definite conclusion. 



EXAMINATION OF BLOOD-STAINS. 121 



CHAPTER VII. 

EXAMINATION OF BLOOD STAINS. 

IMPORTANCE OF THEIR IDENTIFICATION. — THREE METHODS OF IDENTI- 
FICATION. — I. THE CHEMICAL TESTS. — 2. THE MICROSCOPIC TEST. — 
3. THE SPECTROSCOPIC TEST. — BLOOD-CRYSTALS. 

The identification of blood-stains not infrequently con- 
stitutes a most important link in the chain of evidence, in a 
trial for homicide. It is a very common practice for a 
murderer to attribute certain suspicious red stains dis- 
covered upon his garments, or implements, to the blood 
of some domestic animal or bird. Within a few years past 
the resources of science have afforded us material aid in 
distinguishing human blood-stains from those of the inferior 
animals, so that the legal physician may now feel much 
more confident in delivering his testimony in a trial for 
homicide, than he could have done in former years. 

The appearance of blood-stains to the naked eye will vary 
in size, shape and color. Sometimes it may be a mere film 
or smear, but generally it presents the form of distinct spots 
of different sizes; and if the blood has spurted obliquely 
upon a surface, the spots will have assumed a comet-like 
shape, terminating in a bulbous tail. The color of the stain 
will depend (i) upon its freshness: if recent, it will have a 
bright red hue ; if old, the color will be brownish, or brown- 
red. (2) Upon its thickness ; being darker in proportion to 
the density of the stain. (3) Upon the material on which it 
has fallen; if the latter is porous, as soft wood, or linen or 
cotton fabrics, the tint will be rather dull, but if on polished 
and hard substances, such as metals or polished wood, the 



122 MEDICAL JURISPRUDENCE. 

spots have a darker and shining appearance, and on drying 
they are apt to crack from the centre, and may thus easily 
be removed. When dried upon hnen or cotton, they usually 
have a stiffened feel, like a spot of dried albumen or gum. 
If the stains be upon a colored substance, they can best be 
distinguished by artificial light; indeed, they may be err- 
tirely invisible in bright daylight. 

We possess three methods of identifying blood stains : 
(i) the chemical; (2) the microscopic; (3) the spectro- 
scopic or optical. But previously to employing these 
methods, it will be always proper to examine the sus- 
pected spot with a good magnifier; the spot, if a blood stain, 
will frequently exhibit minute coagula or clots of a shiny 
hue, intermixed with the fibres of the material on which it 
is fixed. 

I. Tlie CJiemical Tests. — Before noticing these, it will be 
proper to remark briefly on the solubility of the coloring 
matter of blood. Modern research has shown that the 
coloring matter of blood, when quite recent {hcemoglobm or 
oxy-hcsmoglobin), is very soluble in cold water, but when 
old, so as to have changed to a brown color, it is converted 
into hcBmatin, or deoxidized heemoglobin, which is insoluble in 
water. This is a fact of considerable medico-legal interest. 
For if a garment, or other article stained with blood, is 
immediately washed in cold water, the whole of the blood 
will probably be discharged, so as to leave no trace of it 
behind. But if (as is usually the case) the garment be 
kept for some time before the attempt is made to remove 
the stain by washing, the soluble hcemoglobin will have 
become more or less connected with the insoluble hcematin, 
and enough of the blood will remain upon the article to 
suffice for future identification. Hot water will not remove 



CHEMICAL TESTS FOR BLOOD. 123 

a recent blood stain as effectually as cold water, on account 
of the action of the heat upon the haemoglobin. 

If the blood-spot be recent, the examiner should cut out 
a small piece of the fabric stained, and suspend it, by means 
of a thread, in a test-tube containing cold, distilled water. 
In a few minutes the coloring matter will be observed to 
separate from the material, and to descend to the bottom of 
the water, forming a bright-red solution. If the stain is a 
little older, more time will be required to effect the solu- 
tion, which will have a browner hue; and if the stain is very 
old, there will be no solution whatever. 

If the stain be upon a porous substance, such as wood> 
brick, etc., it should be cut or scraped out, reduced to 
powder, and then soaked in cold water for some hours, and 
afterwards filtered. If the spot be upon a hard metallic 
surface, as a knife, sword, etc., it should be carefully dried, 
when it will be apt to crack off; otherwise it may be 
scraped off with a knife, and the scraping soaked for some 
time in cold water, and afterwards filtered. If the solution 
should not be complete, a little dilute ammonia may be 
added, and if this should fail, Dr. Tidy recommends to use 
a trace of citric acid to effect the solution. 

Having procured the clear red solution, the next step is 
to heat it in a test tube over a spirit lamp. Four results 
are thus obtained: (i) the red color disappears ; (2) coagula- 
tion takes place ; (3) a brownish-green precipitate is formed. 
If there is a sufficient quantity of this precipitate it may be 
collected, dried and heated with a weak ammonia solution, 
which will dissolve it. The solution will appear dark green 
by reflected, and red by transmitted light. (4) A ivcak 
solution of aimnojtia added to it, either produces no change 
of color, or it merely intensifies it. It never changes it to 
green or crimson, as it does with cochineal, and red fruit 



124 MEDICAL JURISPRUDENXE. 

colors. Tincture of galls gives a red precipitate to the 
original solution. A solution of chlorine causes no change 
in it. 

The above tests will suffice to distinguish blood from all 
other red solutions, such as cochineal, kino, madder, log- 
wood, and the various red fruit juices, none of which coagu- 
late by heat, and all of which are changed in color by the 
addition of ammonia. The stain produced by lemon or 
orange juice on the blade of a knife (citrate of iron) after 
exposure to the air, may bear some resemblance to an 
old blood stain ; but the test of tincture of galls, or of 
tannin, to the solution would immediately detect the differ- 
ence. So, the stain from red paint (which contains iron), or 
from iron mould, is easily identified by their solubility in 
dilute muriatic acid, and by subsequently testing for iron. 

TJie Gnaiacinn Test. — This constitutes a beautiful and 
satisfactory portion of the chemical test for blood. Dr. 
Day, of Australia, has experimented extensively upon this 
test, and Prof Taylor has fully confirmed his results. It 
depends upon the following conditions : A freshly-prepared 
tincture of guaiacum, if dropped into water, precipitates the 
resin, which, if exposed to the air, gradually acquires a 
bluish color. If it be exposed to a jar of oxygen gas, the 
blueing process is more rapid ; and if brought in contact 
with ozone, the blue color is instantly produced. Hence, 
the blueing must be owing to oxidation. But it is a remark- 
able fact, as discovered by Schonbein, that antozone^ as found 
in the peroxide of hydrogen (in which the oxygen is in the 
positive state), has no effect at all in changing the guaiac 
resin to a blue color. Moreover, while the resin is blued 
by a variety of mineral and organic substances, the coloring 
matter of the blood has no effect upon it. The guaiacum 
test depends, then, upon the fact that while the blood has no 



THE GUAIACUM TEST. 125 

power to oxidize, or blue the resin, tiie presence of peroxide 
of hydrogen (antozone), which itself has no power to oxidize 
the guaiacum, causes the resin then to be oxidized by the 
blood, and the blue color appears. According to Prof 
Taylor, an excellent way of showing the experiment is to 
add a few drops of the tincture (freshly prepared) to a small 
quantity of water; this will precipitate the resin. Divide 
the water suspending the resin into two portions ; into one 
of them pour a little solution of red coloring matter of 
blood; to the other, add a few drops of ozonized ether 
(peroxide of hydrogen dissolved in ether) ; no change of 
color is observed in either portion. Now, to the first por- 
tion add a few drops of the ether, and to the second a few 
drops of red solution ; in both cases the sapphire-blue color 
will soon be seen. In case the solution is turbid, from an 
excess of the. resin, the addition of a few drops of alcohol 
will instantly clear it, and bring out the fine blue color dis- 
tinctly. If the simple addition of the blood solution to the 
guaiac produces a blue color, we may be certain that some 
oxidizing substance is present besides blood, and which 
conceals its presence. The force of the experiment consists 
in the fact that blood, of itself, will not blue guaiacum, but 
in the presence of ozonized ether, the blue color is speedily 
produced. 

Objections have been raised against this test, on the 
ground that other substances beside blood will produce a 
blue color in the presence of guaiac and peroxide of hydro- 
gen, such as saliva, bile and red wine; but as regards the 
two former, their color should at once distinguish them from 
blood, while the latter substance requires some hours' ex- 
posure to produce the same result ; whereas, in the case of 
blood the effect is immediate. This test is as available for 
old, as for fresh blood, for concentrated, or diluted blood ; 



126 MEDICAL JURISPRUDENCE. 

hence, for a washed-out blood stain, — wherever, in fact, a 
particle of red coloring matter remains. If no blueing 
occurs in the presence of the guaiac and the peroxide, it 
will be safe to affirm that there is no blood present. In an 
old blood-stain, or where it is too small to afford a sufficient 
solution, or where there may be some doubt of its presence 
on a colored material, a very good plan is to moisten the 
spot first with a few drops of water, then with a sufficient 
quantity of the guaiac tincture, and afterwards with a few 
drops of the ozonic ether, and then press upon it a piece of 
white tissue or filtering paper; immediately there will appear 
upon the paper the characteristic blue stain. A number of 
such impressions may thus be taken from one spot, by simply 
adding a little more of the guaiac and the peroxide, and 
repeating the pressure upon the paper. 

The chemical tests will not distinguish arterial from 
venous blood, nor human blood from that of the lower 
animals. The statement of M. Barruel, that if blood be 
shaken up with one-third its volume of pure sulphuric acid, 
a peculiar odorous principle will be evolved, resembling the 
particular animal from which the blood was obtained, has 
been disproved by subsequent investigations. 

II. The Microscopic Test, — This consists in the identifica- 
tion of the blood corpuscles — especially the red ones — by 
means of the microscope. To effect this, the stain (unless 
too old) should be cut out and placed on the glass, or on a 
watch crystal, and moistened with a few drops of pure cold 
water,* a glass rod being pressed against it, to effect the 
separation ; then cover the specimen over with a thin glass, 

* As water alone may cause the corpuscles to swell up, it should be mixed 
with one-seventh part of glycerine, or with a small portion of common salt, 
or sulphate of sodium. 



THE iMlCROSCOPIC TEST. 127 

and examine with a one-fourth inch power, and measure 
the corpuscles with a micrometer. If the stain has been 
washed, very possibly there will be no satisfactory result; 
but the identification of a single red corpuscle would be 
proof of the presence of blood. The white corpuscles may 
sometimes be detected where the red disks cannot be dis- 
tinguished. They are much fewer in number and colorless. 
If very abundant in a specimen, they might be owing to pus 
rather than to blood, or to disease (leukaemia). If only a 
minute speck of dried blood, taken from a weapon or from a 
garment, is to be examined, it may be laid upon the glass, 
which has previously been breathed upon several times, and 
after again breathing upon it, it should be covered with the 
thin slide, and examined, as before. The condensed moisture 
of the breath serves the place of water in breaking up the 
dried clot, without destroying the corpuscles by too much 
dilution (Dr. A. Taylor, from Casper). 

The human blood corpuscle is a round, bi-concave disk, 
without a nucleus. All mammalian corpuscles have the 
same form, with the exception of those of the camel tribe, 
which are oval. The corpuscles of birds, reptiles and fishes 
are oval, larger in size, and nucleated. It is well to remem- 
ber that oval corpuscles may become globular by treatment 
with an excess of water. The outlines of dried blood cor- 
puscles are irregular and jagged, and more or less stellate. 

The average diameter of the human blood corpuscle is 
about the 32^00 of an inch (max. 20V0, min., Woo, Gulliver). 
The average, according to Taylor^ is 35V0 of an inch (max., 
30V0, min., hhi). The corpuscles of most of the lower ani- 
mals are smaller than those of man. The average diameter 
in the monkey is sres of an inch; of the dog, j^Vo; of the 
horse, Woo; of the cow, Wo ; of the goat, Woo ; of the sheep, 
?o^io; of the cat, Wtji; of the pig, i^^so; of the mouse, ssVi; 



128 MEDICAL JURISPRUDENCE. 

of the hare, ^5Vo. From the above enumeration it will be 
seen that the monkey, dog and hare, and, perhaps, the mouse, 
are the animals whose blood corpuscles most closely ap- 
proximate in size to those of man, while those of the 
domestic animals whose blood would be most likely to be 
confounded with human blood, viz., the horse, cozv, pig, 
sheep and goat, are notably smaller than the human. The 
corpuscles of birds, reptiles and fishes, as already mentioned, 
are oval in shape, and considerably larger than those of 
mammals. The long diameter of the corpuscle of the 
common eel is ttit of an inch; the short diameter, 2 8¥2; 
of the shark, long diameter, ttVs, short diameter, t^Vo; of 
the turtle, long diameter, ttst, short diameter, T8V2 ; of the 
Congo lizard, long diameter, sea, short diameter, ^tt; of 
the proteus, long diameter, r^^, short diameter, yiy; of the 
frog, long diameter, ttVf, short diameter, tsVt; of the pigeon, 
long diameter, 2tVo, short diameter, -s-tr^; of the common 
fowl, long diameter, 2x02, short diameter, m^; of the duck, 
long diameter, T9V7, short diameter, 3?¥?. 

The important medico-legal question in connection with 
blood-stains is, whether it is possible to distinguish human 
blood from that of one of the lower animals. Of course, 
there can be no difficulty in recognizing this difference in 
the case of birds, reptiles and fishes ; the shape and size of 
the corpuscles, in each of these orders, will at once make it 
manifest. But as regards the blood of the common domes- 
tic animals, such as the cow, horse, pig and goat, the diffi- 
culty is vastly increased. In a case of homicide, where a 
blood-stained garment might constitute an important link in 
the chain of evidence, and where the accused might very 
naturally assert that the suspicious stains were accidentally 
caused by the blood of one of these animals, it becomes of 
unspeakable importance to be able to decide this point. 



IDENTIFICATION OF HUMAN CORPUSCLES. 129 

Until within a few years it has been considered impossible 
to give a positive answer to this question. To Prof. J. G. 
Richardson, of Philadelphia, is, we think, justly due the 
merit of having demonstrated the possibility of distinguishing 
between human blood and that of the horse, cow, sheep, pig 
and goat — those animals whose blood would be most likely 
to be confounded with that of man. He has conclusively 
shown that, by employing very high microscopic powers, 
such as the fV of an inch objective, magnifying with a 
micrometer eye-piece over 3000 diameters, the human 
corpuscle appears about f of an inch in diameter, whilst 
those of the ox and sheep are about f of an inch in diameter, 
indicating a very obvious difference in their respective sizes. 
The use of the ordinary powers (500 or 600 diameters) fails 
entirely to recognize the difference. 

It is certainly to be regretted, for medico-legal reasons, 
that the size of the blood corpuscles of the monkey, dog and 
rabbit approximates so closely to that of the human corpuscle, 
that it is not possible, by the microscope, nor by any means 
yet discovered, to recognize the distinction between them ; but 
it is equally no slight triumph for microscopic science to have 
accomplished as much as it has done. In several homicide 
cases. Prof Richardson has been able to give most positive and 
valuable testimony as to the identity of human blood-stains, 
by his microscopic researches. His method of procedure is to 
scrape off a minute particle of the suspected blood-clot from 
the stained article with the point of a cataract needle, letting 
it fall upon a clean microscopic slide. A thin cover is then 
laid upon the fragment, and pressed down firmly, so as to 
crush the particle to powder, and the whole transferred to 
the stage of the microscope. Pure water should be intro- 
duced at the margin of the cover, and allowed to flow very 
slowly towards the specimen ; when this is reached, a move- 



130 MEDICAL JURISPRUDENCE. 

ment is observed, after which an aggregation of compressed 
corpuscles, very faint and colorless, but yet very distinct, 
comes into view. These are rendered more obvious by 
introducing at the margin of the cover a minute portion of 
iodine, or red aniline solution.* The author has verified, by 
personal experiment, the correctness of Prof Richardson's 
deductions. On one occasion, specimens of dried human 
blood, together with that of the ox, horse and sheep, were 
submitted, unmarked, to Prof R., for microscopic examin- 
ation, and the correct result was returned in every instance. 

It may be proper to allude to certain bodies that might 
be mistaken, under the microscope, for blood corpuscles, 
such as starch-granules, the sporules of fungi, and the disks 
of coniferous woods. But as these generally possess certain 
special marks by which they can be recognized, they need 
never be confounded with blood disks, by a practiced 
microscopist. 

Blood Crystals constitute another test for blood. They 
can be obtained from all kinds of red blood, being, in fact, 
due to the crystallization of the haemoglobin. To procure 
them, according to Lehmann, evaporate a drop of blood to 
dryness on a piece of glass, add a drop of distilled water, 
and cover the whole with a slip of thin glass. After a time, 
when the water has nearly evaporated, microscopic crystals, 
of various sizes and forms, are visible. Those of man are 
prismatic, or rhomboidal ; those of the inferior animals are 
either similar in shape, or else tetrahedral or hexagonal. In 
order to procure crystals from the blood stains upon a fabric, 
such as linen or muslin, or from a dried coagulum, the pro- 
cess of Kunze and Neumann seems to be the best. This 
consists in soaking the stained portion for several hours in 
a small quantity of cold water, until the coloring matter is 

* Vid. Am. Jour. Med. Sci , July, 1874. 



THE SPECTROSCOPIC TEST. 131 

dissolved ; the reddish solution is then evaporated to dry- 
ness; the dry residue boiled with an excess of glacial acetic 
acid, until a red solution is procured ; this is then slowly 
evaporated on a glass slide until the crystals form, when 
they are examined by a power of 500 diameters. The 
blood crystals appear in groups, frequently crossing one 
another, intermixed with cubic crystals of chloride of 
sodium. But the similarity of human blood crystals to 
those of the lower animals is too great to permit of the 
forming of a positive diagnosis as to their real origin. 
Consequently, they cannot be regarded as affording 
much practical assistance in the identification of blood 
stains. 

III. The Optical or Spectroscopic Test. — The application 
of the spectroscope to the identification of blood depends 
upon the fact that various colored solutions possess the 
power of absorbing different portions of the spectrum, and 
of producing in the latter certain dark lines, just as certain 
vapors and gases affect the spectrum. Blood, in this respect, 
produces a very decided effect, causing absorption bands 
(dark lines), which are very characteristic of its presence, 
even in minute quantities. 

It will be remembered that in perfectly fresh arterial 
blood, the coloring matter exists as hcemoglobin. (i) When 
this is examined by the spectroscope, it will be seen to pro- 
duce two absorption bands in the spectrum, in the yellower 
half of the green space, the lower one being twice as broad 
as the upper ; also the blue end is darkened. When haemo- 
globin is acted upon by acids and alkalies, or kept for a long 
time, especially in a damp place, it acquires a brown color, 
becomes deoxidized, and is finally changed into hcematin. 
(2) The spectrum of deoxidized haemoglobin, or of venous 



132 MEDICAL JURISPRUDENCE. 

blood, shows a single broad absorption band, visible in the 
green; the blue end is also darkened. (3) After a short 
exposure to the air (jnethcEmoglobifi), it gives a spectrum 
with the blue end darkened, the two bands of oxidized 
haemoglobin much weakened, with a third band visible in 
the red. (4) The spectrum of deoxidized hsematin, or of 
blood after prolonged exposure to air, shows the blue end 
darkened, and two well-defined bands in the green, but 
stronger than in (i), and with disappearance of the band in 
the red. 

The form of apparatus best adapted for spectroscopic ex- 
amination of blood is that suggested by Mr. Sorby, to 
whose researches we are chiefly indebted for our knowl- 
edge in this branch of investigation. It is a combination 
of the microscope and spectroscope. The blood solution is 
prepared in the same manner as that described above for 
the chemical tests. The details of the examination by the 
spectroscope would exceed the limits of this work ; the 
reader is referred to the larger treatises for a fuller de- 
scription. 

The important question in this connection is — Do other 
substances give similar spectra to those of blood ? Accord- 
ing to Mr. Sorby, nothing gives a spectrum precisely similar 
to that produced by oxy-hsemoglobin, although certain 
other bodies produce absorption lines somewhat resembling 
the former, but easily distinguishable by a practiced observer. 
Thus, the coloring matter of the petals of Cineraria give 
two absorption bands; but they are easily distinguished 
by the action of ammonia. Cochineal, madder, and other 
red dyes, dissolved in alum, although affording bands some- 
what resembling those produced by blood, may be distin- 
guished from the latter by the use of ammonia and potassic 
sulphite. 



THE SPECTROSCOPIC TEST. 133 

We must, therefore, admit that the spectroscope, in the 
hands of a skilled operator, afifords the most certain and 
dehcate test known for the presence of blood. It cannot, 
however, discriminate between human blood and that of any 
of the lower animals ; in this respect, therefore, it is inferior 
to the microscope as a test. 



134 MEDICAL JURISPRUDENCE. 



CHAPTER VIII. 

BURNS AND SCALDS. 

DEFINITION. — CLASSIFICATION. — SYMPTOMS. — CAUSE OF DEATH. — 
POST-MORTEM APPEARANCES. — DISTINCTION BETWEEN BURNS MADE 
BEFORE AND AFTER DEATH. — ACCIDENTAL, SUICIDAL AND HOMI- 
CIDAL BURNS. — SPONTANEOUS COMBUSTION. 

A burn is an injury to the body, caused by heat appHed 
either in the form of a heated sohd substance, or by flame, 
or by radiant heat. 

A scald is an injury produced by a hquid, heated above 
a certain point, apphed to the body. 

Burns and scalds are not, strictly speaking, zvomids ; 
though legally they are comprised under the term bodily 
i7tjuries. The effects of corrosive liquids, such as sulphuric 
and other mineral acids, and the strong alkalies, closely 
resemble burns, and they are so regarded in law. Boiling 
liquids taken internally may produce internal scalds. 

The intensity of a burn is dependent upon the degree of 
heat applied; it varies from a slight redness, to a complete 
charring of the tissues. Metals heated to redness produce 
very severe burns, even to the destruction of the flesh ; but 
if in a state of fusion, the injury is yet more serious, in con- 
sequence of the partial adhesion of the molten mass to the 
skin. Boiling oils produce as decided effects as hot solids 
or molten metals. Boiling water causes scalds, more or less 
severe, attended with vesications containing serum ; but it 
never chars, or destroys the tissue. 

According to Dupuytren, burns may be classified as 
follows : — 



CLASSIFICATION OF BURNS. 135 

( 1 ) Superficial inflammation of the skin, without vesication. 

(2) Vesication, or bhsters, containing serum, sometimes 
clear and sometimes opaque and bloody. If the cuticle be 
removed, the true skin is very red and granulated, and 
secretes pus. 

(3) Destruction of the external surface of the true skin, 
forming an eschar, which may be soft and yellow if made 
by a liquid, or hard and brown, or black, if resulting from a 
solid. The surrounding skin is red and blistered. This 
form of burns leaves ugly cicatrices, which are white and 
shining. 

(4) Disorganization of the whole skin : these differ from 
the last only in the deeper destruction of the parts, and in 
the thickness of the sloughs. The resulting scars are 
puckered, and depressed below the level of the skin. 

(5) The destruction here extends through the skin, and 
includes the cellular tissue and a portion of the muscles. 
The general character is the same as in (4). 

(6) Complete carbonization of the burnt part, as when a 
portion of the body is roasted by the fire. 

The important medico-legal question to determine is — was 
the burn upon the body made before, or after death? It is 
evident that an assassin might murder his victim, and then 
set fire to the house, hoping thus to escape detection. If a 
body be found completely charred, it will be impossible to 
determine whether it was living or dead when acted upon 
by the heat. 

As regards vesications, which result from moderately 
heated solids, or from scalding liquids, if they contain 
serum, their presence, as a rule, indicates that the burn was 
inflicted during life. The experiments of Christison, Taylor 
and Tidy go to show that, although the application of heat 
to a body zvitliiii a feiv uiimitcs after death may sometimes 



136 MEDICAL JURISPRUDENCE. 

produce a blister, this does not contain serum, but only air; 
serous exudation must be regarded as vital. There may be 
an exception to the above rule in the case of dropsical sub- 
jects, in whom it is stated, on good authority, that serous 
blisters may be produced after death, by the application of 
heat. But, on the other hand, the absence of vesication 
should not be regarded as a proof that the burn was not 
inflicted during life, since vesication is not always a neces- 
sary result of a burn ; besides, it is quite possible that only 
the more serious results maybe visible. It is recommended, 
in all doubtful cases, to examine the cuticle minutely, with 
a lens, for minute apertures through which the serum may 
have escaped. 

Another sign of burning during life is the presence of a 
red line around the burn, which gradually merges into the 
color of the surrounding skin. This red border remains 
after death, and cannot be produced, according to Christi- 
son and Taylor, by the application of heat to the dead 
body. Dr. Tidy's conclusions {Legal Med., vol. I, p. 482), 
based upon a series of his own experiments, are that ''where 
there are serous blisters on a dead body, the serum being 
thick and rich in albumen, and the blisters surrounded by 
a deeply injected red line, the true skin, after the removal 
of the cuticle, also presenting a reddened appearance, the 
evidence is strong that the burn was produced during the 
life of the person; while it is conclusive that it was caused 
during the life of the part. But if the blister contained air, 
the true skin, after the removal of the cuticle, appearing dry 
and unglazed, of a dull white color or grayish ; or, if the 
blister contains a little thin, non-albuminous serum, there 
being in neither case any red surrounding line, nor any in- 
jected condition of the cutis vera, the evidence is strong that 
the burn was inflicted after death." 



POST-MORTEM APPEARANCES OF BURNS. 137 

The Danger of burns depends more on their extent than 
their depth. The reason of this is that extensive burns 
involve a greater number of sensory nerves, and a greater 
extent of surface is prevented from performing the function 
of excretion and heat regulation. Thus, a large superficial 
scald, especially in young children, is very apt to prove 
fatal, the symptoms being stupor, somnolence, pallor of 
face, and feeble pulse, with slow and stertorous breathing — 
very similar to those of narcotic poisoning, for which, indeed, 
they have sometimes been mistaken. It has been ascer- 
tained that if one-half to two-thirds of the entire skin be 
involved, the burn will certainly prove fatal; but practi- 
cally, one involving one-third of the body, if severe, would 
be very likely to cause death. But here, many circum- 
stances will have to be considered, such as the age, consti- 
tution, tJie part affected, and the character of the burn. Burns 
are more dangerous in the young; more so on the trunk of 
the body than on the limbs; and more so if in separate 
patches than if continuous, provided they are of equal 
extent. Gunpowder burns are considered more dangerous 
than those produced by steam. 

The Causes of death in burns are various: as (i) bodily in- 
jury ; as in the case of conflagrations of buildings, where 
instantaneous death may result from the fall of timbers, 
walls, etc., or from leaping out of a window, or from a roof 
(2) Suffocation, either from the smoke, or from the want of 
air. (3) Shock ; this is probably the most frequent cause 
of death after extensive burns. (4) Coma, convulsions or 
tetanus. (5) Bronchitis, pneumonia and other thoracic 
symptoms. (6) Enteritis and peritonitis. (7) Exhaustion. 
(8) Gangrene, pyaemia, etc. 

TJie Post-nwrteni appearances. — These are often by no 
means well marked, the most constant lesions being a 

7* 



138 MEDICAL JURISPRUDENCE. 

capillary injection of the mucous membrane of the ali- 
mentary canal and bronchi, and serous effusion into the 
ventricles of the brain. In cases where the death has oc- 
curred from injury, or from suffocation, the usual lesions 
would, of course, be discovered after death ; but if the body 
has been completely charred or roasted, it will probably be 
impossible to distinguish anything to enable us to form an 
opinion as to whether the death had preceded the burning 
or not. The means of identifying the charred remains of a 
burnt body have already been pointed out (ante, p. 88). 

Wounds 2ipon the burned. — From the fact that murder is 
frequently committed, and the body subsequently burned 
by a criminal, with a view of destroying the traces of his 
crime, it is important for the legal physician always to ex- 
amine the body for zvounds. There are certain mechanical 
effects produced upon the body by fire, which might possi- 
bly be mistaken for wounds made before death, such as 
fissure in the thorax or abdomen, or in the neighborhood 
of the large joints. These fissures are generally irregular 
in form, and, as the blood vessels, by their elasticity, are 
apt to escape being torn, these may be seen intact, stretch- 
ing across the fissure. This appearance is always indicative 
that the opening was caused by heat, and was not a real 
wound. A case is mentioned in which two old people were 
found burned in their house ; the fact of their having been 
previously stunned, if not killed, by blows on the head, was 
ascertained by the existence of fractures of the skull, under 
which coagulated blood was found upon the dura mater. 
Where the heat has been excessive, the bones of the de- 
ceased may be found more or less cracked or split, and 
sometimes even crumbled to pieces. Ordinary incised, 
punctured or contused wounds, made before death, could 
not be identified in a body completely charred by fire. 



SPONTANEOUS COMBUSTION. 139 

As to the question of the burning being accidental, suicidal 
or homicidal, it may be assumed that death by burning is 
nearly always accidental ; and such cases are, unfortunately, 
of frequent occurrence. Death, in such instances, mostly 
occurs at some distance from the fire. The fact that a dead 
body is found near the fire does not, however, preclude the 
idea of accident, since an intoxicated or a diseased person 
may have caught fire, and been unable to remove. In all 
such cases it is important to examine the body for marks of 
violence, with the precautions given above. Furthermore, 
a case might present itself where severe wounds were found 
on a burnt body, and the question might arise whether the 
wounds, or the fire had been the cause of death ? No 
general rules can be given for guidance in such cases ; each 
one must be determined by the attending circumstances. 

The question oi Spofitaneous Combustion of the human body 
presents itself here for a brief notice. It has occasioned 
considerable discussion in the scientific world for many 
years past, but although some remarkable instances are 
related of apparent spontaneous combustion of the human 
body, originating while alive, we believe that, on close inves- 
tigation, it will be found that some source of fire had invari- 
ably been present, from which the combustion took its 
origin — such as a lighted pipe or candle, — and that the body 
was that of an habitual spirit drinker, and nearly always that 
of a very fat woman — conditions highly favorable for the 
process of combustion, zvhoi once originated. 

From the known composition of the human body — nearly 
75 per cent, being water — it would seem to be chemically 
and physiologically impossible even to burn up a dead body, 
except on the application of an extraordinary degree of heat, 
such as is required by the process of cremation. Certainly, 
the weight of authority is against the belief in spontaneous 



140 MEDICAL JURISPRUDENCE. 

combustion of the human body ; no person of position or 
authority has ever witnessed such a phenomenon, and we 
must therefore express our disbehef in it, and assign the 
wonderful accounts which from time to time have appeared 
in the newspapers and books to the region of romance and 
fiction. 

It is, of course, an admitted fact that various organic 
and Tni7ieral substances undergo spontaneous combustion, 
through the agency of absorbed oxygen, especially when 
exposed to the action of the air, in a state of fine powder or 
extended surface. Conflagrations of large buildings have 
frequently thus originated, involving important legal ques- 
tions as to incendiarism. 



VIOLENT DEATH FROM APNCJEA. 141 



CHAPTER IX. 

VIOLENT DEATH FROM DIFFERENT FORMS OF APNCEA 
(ASPHYXIA). 

This includes death from Suffocation, Strangulation, 
Hanging and Drowning, in all of which life is destroyed 
chiefly, if not exclusively, by apnoea or asphyxia. All these 
modes of violent death possess certain points in common, 
while, at the same time, each of them is distinguished by 
individual peculiarities, which render a separate consideration 
desirable. Their common properties will be first briefly 
considered. 

In all cases of apnoea, it will be remembered that death 
begins in the lungs, and that this is brought about simply 
by excluding the air (oxygen) from these organs. This is 
accomplished by numerous and diverse means : as by 
mechanical pressure upon the throat or thorax, as in 
throttling ; by a ligature around the throat, as in hanging 
and strangling ; by the flow of water into the windpipe, 
as in drowning ; by foreign bodies getting into the larynx 
and trachea, as in choking; by being shut up in a box 
(entombed alive), or buried under ruins, or a sand bank, or 
snow drift ; or by some disease of the throat, as oedema of 
the glottis, membranous croup, etc.; — all of which produce 
death simply by arresting the function of respiration. 

Likewise, there are exhibited certain signs or phenomena, 
both before and after death, which indicate death by apnoea. 
These are lividity of the lips, fingers, and other extremi- 
ties, and generally of the whole face, together with a 
swollen appearance of the countenance ; convulsive move- 



142 MEDICAL JURISPRUDENCE. 

ments of the arms and legs, at first partly voluntary, but 
soon becoming spasmodic and involuntary, as seen in the 
struggles to breathe ; the veins become turgid ; the pulse, at 
first fiiU and rapid, soon becomes feeble; there is often 
frothing at the mouth, which may, at times, be tinged with 
blood ; there is frequently turgescence of the genital organs, 
with involuntary discharge of semen, urine and faeces. 
Abortive attempts at respiration are made for awhile, but 
finally these cease, and the heart at last ceases to pulsate. 

Consciousness is lost very early, although in the earliest 
stage there is a remarkable activity of the senses ; the 
memory is surprisingly acute, so that the events of a life- 
time seem to be crowded into a moment. But this stage 
only lasts for a very brief space of time ; such is the testi- 
mony of persons who have been rescued from drowning, or 
who have been cut down from hanging, and of those who 
have experimented upon themselves by partial strangulation. 

This kind of death is rapid, not requiring more than three 
to five minutes, though there are some apparent exceptions 
in the case of drozvning. These will be referred to here- 
after. 

The post-mortem appearances in all these varieties of 
death by apnoea are, in the main, very similar. These are 
lividity of the lips, fingers and other parts of the body, as 
seen before death ; in drowning, the face is apt to be pale ; 
sometimes, likewise, in hanging. The venous system is gen- 
erally full of blood. The right side of the heart, together 
with the lungs, is usually gorged with dark blood; the 
mucous membrane of the bronchial tubes deeply congested. 
In young persons, the blood vessels of the lungs will often 
be found empty, and the lungs emphysematous, from the 
violent efforts made to respire. Minute extravasations of 
blood (ecchymoses) are found in the mucous and serous 



SUFFOCATION. _ 143 

membranes, as the pleura, pericardium, endocardium, peri- 
toneum, etc. (Tardieu). The veins and sinuses of the brain 
are usually tinged with blood, and the brain itself filled with 
bloody points. The solid viscera, as the liver, spleen and 
kidneys, will generally be congested. The blood itself is 
mostly fluid and dark colored, except in suffocation from 
carbonic acid, when its color is bright red. 

SECTION I. 
DEATH BY SUFFOCATION. 

ACCIDENTAL SUFFOCATION. — SUICIDAL AND HOMICIDAL SUFFOCA- 
TION. — POST-MORTEM SIGNS. 

Suffocation, properly speaking, includes every variety of 
death resulting from an impediment to respiration. But, as 
Strangulation, Hanging and Drowning are considered sepa- 
rately, the term is here restricted to the other modes of 
death by apnoea. 

Cases of accidental suffocation are numerous. Infants 
have thus perished by being too closely wrapped up, or by 
being overlaid by their mothers, who are often intoxicated. 
Young children, feeble persons, epileptics and drunkards, 
have been suffocated by falling into ashes, soft mud, feathers 
and similar articles. Mechanical pressure on the thorax, as 
occurs in vast crowds of people, has destroyed life by suffo- 
cation. The accidental slipping into the larynx of small 
bodies, such as peas, grains of corn, marbles, etc., from the 
mouth, particularly in children ; the lodgment of a piece of 
meat in the air passages (choking), from over-haste in eat- 
ing ; the detachment of a bronchial gland which became 
impacted in the larynx ; the escape of a lumbricus from the 
stomach, and its entering the larynx ; the passing of vomited 
matters into the windpipe; various disorders of the throat, 



144 MEDICAL JURISPRUDENCE. 

as oedema and spasm of the glottis, croup, diphtheria, 
abscess, etc. — all these are examples of accidental suffoca- 
tion. 

Suicidal suffocation is extremely rare, though a few re- 
markable cases are mentioned by authors, in one of which — 
that of a young woman — death was caused by a ball of hay 
which she had thrust down the throat into the pharynx, 
behind the larynx, and which was just visible when the 
mouth was widely opened (Year Book of Med. ajtd Surg., 
1864, p. 458). 

Homicidal suffocation is usually practiced upon infants, 
the aged, or those who are otherwise helpless. Suffocation 
is undoubtedly a very common mode of destroying new- 
born children ; it is very easily effected, and leaves behind 
it no characteristic traces ; death, in such cases, being 
usually attributed to convulsions. The notorious Edin- 
burgh murderers, Burke and Hare, destroyed their victims 
by suffocation by forcibly closing their mouth and nostrils, 
and at the same time bearing their whole weight upon their 
breast. A curious Scotch case is mentioned, where an in- 
temperate woman, between sixty and seventy years of age, 
was found dead with a wound upon the scalp, emphysema 
in the chest, and seven ribs fractured. The face was pale 
and composed, the eyes closed, and the tongue slightly 
protruding. On examination, the cork of a quart bottle 
was found in her larynx, the sealed end being uppermost. 
The epiglottis, trachea and larynx were considerably injected. 
It was attempted, on the trial, to show that the deceased 
had drawn out the cork with her teeth, but that it was sud- 
denly forced into her windpipe, while she was dead drunk. 
But this was negatived by the fact that the sealed end of the 
cork zvas uppermost, and also by the marks of the corkscrew! 
It was thence concluded that the cork had been forcibly 



POST-MORTEM SIGNS OF SUFFOCATION. 145 

pushed into her windpipe, while she was unable to resist, 
through intoxication. Another case of homicidal suffoca- 
tion is related (Woodman and Tidy's Foren. Med., p. 851), 
of a Russian sentry on guard, being found dead in his 
watchbox, with a large piece of meat in the lower part of 
the pharynx, pressing upon, and partly in the glottis. His 
death was therefore supposed to be accidental. Some years 
after, his superior officer, in dying, confessed that he had 
first suffocated the man, and then placed the piece of meat 
in his throat, in order to divert suspicion from himself. 

Post-mortem appearances. — Lividity and swelling of the 
face and lips, though often, in accidental cases, the face is 
placid ; the eyes are congested ; minute ecchymoses on the 
neck and chest ; mucous froth, sometimes bloody, about the 
mouth and nose ; the lungs and right side of the heart may 
be gorged with dark blood, although in some cases, especially 
of young children, the lungs may be empty of blood and 
emphysematous. Tardieu lays great stress upon the presence 
of minute punctif or m ecchymoses, especially on the lungs of 
new-born infants, who have been suffocated. These spots 
are also found on the pleura, lining membrane of the heart, 
membranes of the brain, peritoneum, and mucous lining of 
the windpipe. Other authorities, among whom is Dr. 
Ogston, deny that these extravasations are peculiar to cases 
of suffocation, as they are found in other modes of death. 
The blood is dark and very fluid. The kidneys are deeply 
congested. 

As these post-mortem signs are also found in other forms 
of death by apnoea, they cannot be considered as character- 
istic of death by suffocation. Consequently, the examiner 
should be cautious in expressing his opinion as to the cause 
of death. If a dead body be discovered in sand, earth, ashes, 
or similar substances, the question whether it was placed 



146 MEDICAL JURISPRUDENCE. 

there before or after death must be decided by a careful 
examination. If the substances be found in the air passages, 
and especially in the oesophagus and stomach, it maybe 
concluded that the person was alive at the time. 

SECTION II. 
DEATH BY STRANGULATION. 

MODES OF STRANGULATION. — EXTERNAL SIGNS. — INTERNAL LESIONS. 
— ACCIDENTAL, SUICIDAL AND HOMICIDAL STRANGULATION. — MARK 
OF THE CORD. 

Strangulation is produced either by pressure upon the 
neck by means of an encircling cord, or by direct pressure 
made by the hand on the windpipe, as in throttling. The 
means by which the constriction is produced are various : 
sometimes a rope is used, sometimes a strap, a handker- 
chief, a ribbon, or a strip torn from a sheet or the clothing. 
In Spain, the usual mode of execution of criminals is by the 
garrotte — a steel collar tightened by a screw ; in Turkey, it 
is by the bow string. Death results, in most cases, from the 
combined effect of the deprivation of atmospheric air, pro- 
ducing apnoea, and from congestion of the brain, due to the 
pressure upon the jugulars, preventing a return of blood 
from the brain. It differs from hanging chiefly in the 
obliquity of the cord around the neck in the latter, while 
in strangulation, the cord is wound horizontally around the 
neck. It is important, medico-legally, to distinguish be- 
tween death from strangulation and death from hanging, as 
the former is nearly always the result of homicide, while 
the latter is usually to be traced to suicide. The first ques- 
tion that presents itself here is — was the death caused by 
strangulation? The appearances of one strangled are usu- 
ally very distinctly marked : these are livid and swollen 



SIGNS OF STRANGULATION. 147 

face; staring eyes, with dilated pupils, and protruding 
tongue, which may be bitten ; livid extremities ; flattened 
larynx ; blood may issue from the nose, mouth, or even 
ears ; the face, neck, chest and eyes are studded with ecchy- 
moses; the genital organs frequently turgid; and there may 
be an escape of urine and faeces, as in hanging. Internally, 
the right heart and venous system are sometimes gorged 
with blood ; but this is less frequent than in other forms of 
death from apnoea; this is also true of the congestion of the 
liver and kidneys. Tardieu states that the lungs are seldom 
very full of blood, but he places great reliance upon the 
emphysematous appearance of these organs, arising from a 
rupture of the pulmonary vesicles. The sub-pleural ecchy- 
moses, which he regards as characteristic of suffocation, 
he says are rare in strangulation. There are also extrava- 
sations of blood in the lungs, but none in the brain, whereby 
it is distinguished from apoplexy, which it resembles in a 
few of its symptoms. 

Among the external signs, the marks of the cord, and of 
the fingers on the neck deserve special attention. These 
are more evident and reliable here than in hanging, because 
in homicidal strangulation very considerable force is gener- 
ally employed by the murderer, in order to accomplish his 
object. If the hand has been used, as in throttling, the 
marks of the fingers will be found upon the front of the 
throat, sometimes of two or more fingers and the thumb, so 
that the particular hand employed may even be determined. 
If a cord has been used, the mark will be horizontal, not 
oblique, as in hanging ; sometimes there may be two or 
three parallel marks, where the cord has been wound around 
the neck several times. The mark of the cord is apt to be 
less deep than in hanging, and subcutaneous extravasation 
is not always found ; but the parts beneath may show con- 



148 MEDICAL JURISPRUDENCE. 

siderable infiltration of blood. Fractures of the hyoid bone, 
and of the ossified thyroid cartilages are reported as having 
occurred. The interior of the larynx and trachea is con- 
gested, of a uniform red or violet color, and is coated over 
with a frothy, bloody mucus, which extends also into the 
smaller air tubes. This internal discoloration of the wind- 
pipe should not be mistaken for the early signs of putrefac- 
tion of this organ ( Vid. ajite^ p. ^f). 

The mark of the cord around the neck may unquestion- 
ably be produced on the dead body, if the attempt is made 
within a few hours after death, and while the body is still 
warm, but not (according to Casper) after six hours. There- 
fore, this one particular sign should never be relied on to 
the exclusion of the other characteristic evidences of death 
by strangulation, such as the livid, swollen countenance, the 
protruded tongue, the staring eyeballs, etc., none of ivhich 
are produced by strangidation after death. Hence, although 
a murderer may place a cord around the neck of his dead 
victim, with a view to make the case simulate a suicide, 
there will be little difficulty in detecting the ruse. 

Was the strangling accidental^ suicidal or homicidal f Cases 
of accidental strangulation not unfrequently occur. Prof. 
Taylor records two : one, of a girl carrying fish in a basket, 
which was strapped around the upper part of her chest in 
front. She was found dead, sitting on a stone wall. The 
basket had probably slipped off while she was resting, and 
had thus raised the strap, which firmly and fatally com- 
pressed the trachea. The other case was that of a boy, 
whose silk necktie, knotted and tightly twisted around his 
neck, was caught in the band of an engine, and his neck 
drawn down against one of the revolving shafts. He was 
rescued after his neck had been compressed at least one 
minute. He became black in the face, and blood escaped 



SUICIDAL STRANGULATION. 149 

from the mouth and ears. For several minutes after the 
removal of the ligature, he was insensible, but ultimately 
recovered. Another instance is related by Dr. Gordon 
Smith, of a lad who used to carry a heavy weight sus- 
pended from his neck by a string. One day he was found 
quite dead, sitting in a chair. He had probably gone to 
sleep, the weight had slipped, and drawn the cord tight 
around his neck. 

Sutdda/ strsingulsLtion is comparatively rare, except among 
the insane, with whom it is by no means uncommon. The 
facility of effecting their purpose by such simple means as 
a garter, a ribbon, a handkerchief, or a strip torn from a 
garment, may readily account for such occurrences, and 
still further, when it is remembered how very rapidly and 
insidiously unconsciousness steals over the senses under a 
pressure of the windpipe, thereby taking away from the in- 
dividual the will and the power to escape. A case men- 
tioned by Dr. Taylor (Med. /iinsp.) will illustrate this. An 
insane gentleman, with suicidal tendencies, was placed in a 
private asylum, with especial directions to watch him closely, 
to prevent his taking his life. Two attendants were placed 
over him. On retiring to his bed, these attendants remained 
at his bedside ; but on his requesting them to retire to a 
little distance, they complied, still keeping a close watch 
upon him. Two hours afterward, the physician, on visiting 
the patient, was informed by the attendants that he had been 
sleeping quietly for some time. On approaching the bed, 
to their horror and surprise, they found the gentleman 
dead ! He had strangled himself simply by tearing off a 
strip from the bottom of his shirt, rolled it into a cord, and 
tied it around his neck. Other cases of strangulation are 
recorded of determined suicides, where the cord was found 
coiled around the neck several times ; in one instance, the 



150 MEDICAL JURISPRUDENCE. 

ligature had been tightened by a stick thrust in and twisted 
like a tourniquet ; and in still another, a sabre had been 
used for the same purpose. 

Homicidal strangulation, as already mentioned, is the 
most frequent variety of this form of violent death. It is 
usually recognized by the marks upon the neck and else- 
where, indicating a greater amount of violence employed. 
Thus, the impression of the ligature on the neck will be 
deeper and more ecchymosed than occurs in a suicide ; it 
may also be accompanied by the marks of the fingers on 
the throat, which latter are never found either in a suicidal 
or accidental case. Besides these, there will frequently be 
seen contusions or injuries of other parts of the body, and 
other evidences of a struggle. 

It should not be forgotten that the marks of homicidal 
strangulation may often be discovered many weeks, or even 
years, after burial. One is mentioned by Wharton and 
Stille {Med. Jiirisp., vol. II, p. 830), where, after thirty-eight 
days' interment, the evidence of strangulation was obtained 
chiefly from the striking contrast of the integuments of the 
neck with those of the rest of the body. There was a white, 
shriveled space over the larynx, half an inch broad ; also a 
groove around the neck, of a blackish-brown color and 
parchment-like appearance ; this condensed skin was diffi- 
cult to cut, and its section was perfectly dry and yellowish- 
white. Another remarkable case occurred in Paris, where 
the body had been buried several years, and was reduced 
almost to a perfect skeleton. Several of the cervical verte- 
brae, together with the right clavicle, were found held 
together by a blackish mass, in the composition of which 
no tissue could be recognized. This mass was surrounded 
by several twists of a cord two lines in diameter. The cord 
was much decayed, showing no knots, and its direction was 



HANGING. 151 

horizontal. The above facts enabled Orfila and other medi- 
cal jurists to decide that the woman had perished by stran- 
gulation. 

SECTION III. 
DEATH BY HANGING. 

CAUSE OF DEATH IN HANGING. — POST-MORTEM APPEARANCES. — 
CORD-MARK. — GENERALLY SUICIDAL. 

Hanging is that mode of death caused by suspension of 
the body by the neck, the weight of the body acting as the 
constricting force. Physiologically, it is the same as stran- 
gulation, and, like the latter, the cause of death is partly 
apnoea and partly cerebral congestion, and more frequently 
a combination of the two. The following table exhibits the 
relative frequency of each form of death : — 

Apoplexy, ..... 

Asphyxia (Apnoea), 

Mixed, . . . . . 



emer. 


Casper. 


9 


9 


6 


14 


68 


62 



83 85 

If the cord encircles the neck below the thyroid cartilage, 
the death is more rapid, and is to be ascribed to apnoea; but 
if higher up, as in executions, where it is apt to slip under 
the chin, some little space on either side may escape con- 
striction, so as to admit a slight amount of air into the 
lungs ; in this case the death will be slower, and be due 
rather to cerebral congestion. In the great majority of 
cases, however, as shown by the above table, the cause of 
death is of a mixed nature. In some cases of public execu- 
tions, where the fall was very considerable, and where a 
violent rotary swing was given to the body of the criminal 
at the moment of the drop, the odontoid process of the 
second cervical vertebra has been found either fractured or 
dislocated, causing immediate death, owing to pressure on 
the spinal cord. But death, in hanging, from fracture of the 



152 MEDICAL JURISPRUDENCE. 

vertebrae, is far less frequent than is popularly imagined. 
Orfila states that in the bodies of fifty persons who had 
been hanged he met with a fracture of the os hyoides in 
only one case, while he had never met with a fracture or 
luxation of the vertebrae. 

There is reason to believe that death by hanging is nearly 
painless. The convulsive movements of the limbs, as is 
well-known, are no indications of suffering. Unconscious- 
ness very speedily supervenes, especially if the trachea is 
compressed, and death occurs in a very few minutes. Per- 
sons who have been cut down after a few minutes' suspension 
are very rarely resuscitated. And even after an apparent 
partial recovery, death often follows from secondary effects, 
especially from congestion of the brain. 

The insidious manner in which the loss of consciousness 
steals upon the brain in hanging deserves especial notice, 
because it satisfactorily explains the facility with which 
death takes place, even when the suspension of the body is 
not complete, but when there has been simply a pressure 
of the ligature against the windpipe, the person meanwhile 
resting on the knees or toes, or being in a semi-recumbent 
posture. 

Post-mortem appearances. — In the main, they resemble 
those attending death from strangulation. Externally, swell- 
ing and lividity of face, congestion of the eyelids, dilated 
pupils, eyes red and protruding, tongue swollen, livid, often 
protruded or compressed between the teeth, lower jaw 
retracted, often a bloody froth escaping from the mouth and 
nostrils. In addition, there are often petechial effusions on 
the neck, shoulders, arms and hands. In many cases, how- 
ever, the countenance is calm, the face pale, the eyes and 
tongue natural. Sometimes there is turgescence of the 
genital organs, with an involuntary escape of the urine. 



SIGNS OF HANGING. 153 

faeces and semen ; but these signs are by no means peculiar 
to death by hanging. The position of the head varies 
according to the part of the neck where the knot was 
placed. As the latter is usually behind the neck, the head 
is generally flexed forward. If the knot were in front, the 
head would be found extended backward (Tardieu). The 
hands are generally closed, often tightly ; the legs extended, 
and often livid. The neck is nearly always stretched, owing 
to the weight of the body, and it presents very decided 
marks of the cord, varying however somewhat, according 
to the nature of the latter and its mode of application. 
Thus, the mark may be deep or superficial, single or double, 
according to the strain made upon it, and its thickness, 
roughness, or duplication. The skin under this mark be- 
comes very dense and tough, and of a yellowish-brown 
color, and has been aptly compared to old parchment. This- 
appearance is more marked some hours after death, if the 
cord has been removed ; and the cellular tissue underneath 
is also condensed, and has a silvery appearance. Besides 
the above, there is often a livid mark (ecchymosis), where 
great violence has been used, as in executions ; but the 
latter is quite distinct from the true mark of the cord, with 
which it has been confounded. The livid line is much less 
frequently met with than was formerly supposed. 

The groove or furrow in the neck, in the great majority 
of cases, will be found between the chin and larynx ; its 
direction is oblique (which distinguishes it from strangula- 
tion) ; it may also be double (arising from a double fold of 
the cord), and irregular or interrupted. In general, the 
narrower the ligature, and the longer the suspension, the 
deeper the furrow. A broad leather thong, pressing only 
by its borders, might produce a double mark. 

Internally, the appearances usually accompanying as- 
8 



154 MEDICAL JURISPRUDENCE. 

phyxia are met with, such as engorgement of the lungs, 
right side of the heart, and venous system with dark fluid 
blood. The lining membrane of the larynx and trachea is 
deeply congested, as in strangulation, and is sometimes 
coated with a bloody froth. The vessels of the brain are 
generally congested, but extravasation of blood into the 
brain, or upon its membranes is extremely rare. The brain 
itself, when cut into, presents numerous bloody points. The 
kidneys are usually congested ; the stomach frequently pre- 
sents evidences of such deep congestion as to suggest the 
idea of an irritant poison. The same is true also of the 
intestines. Dr. Yellowly has found coagulated blood on 
the mucous membrane of the stomach, in two out of every 
five cases of death by hanging. 

Among the occasional lesions may be mentioned fracture 
of the hyoid bone and thyroid cartilage, and rupture of the 
internal and middle coats of the common carotid artery. 
According to Dr. Dyer (Nezv York Med. Jour., 1866), a 
transverse fracture of the crystallme lens is a frequent result 
of death by hanging. He discovered it in three cases out 
of four, one of a man, and three of dogs. Some years ago 
these experiments on dogs and cats were repeated by one 
of the author's students, at the University of Pennsylvania, 
but in every instance with a negative result. 

An important medico-legal question to settle is — was the 
death caused by hanging f This cannot always be satisfac- 
torily determined by mere medical evidence, since there are 
no positive or characteristic signs of this kind of death. 
The mere suspension of the body is no proof, since a mur- 
derer might easily suspend the body of his victim, in order 
to divert suspicion from the true cause of death. The mark 
of the cord can be imitated by suspending a dead body by 
the neck immediately after death, and, according to Casper, 



HANGING SUICIDAL, HOMICIDAL OR ACCIDENTAL? 155 

even up to seventy-two hours after, especially if the body 
be forcibly pulled downward. The livid or ecchymosed line 
is less likely to be found, under these circumstances, than the 
brownish, parchment-like furrow. Hence, it follows that the 
mark of the cord cannot be regarded as evidence of death 
by hanging; and the other usual signs, such as turgescence 
and lividity of the face, congested eyes, swollen tongue, etc., 
are all met with in strangling, and other forms of death, 
while these very signs may be absent in certain cases of 
hanging. Dr. R. F. Hutchinson states that an invariable 
sign of death from hanging is the flow of saliva out of the 
mouth, down the chin, a?id straight down the chest. The 
appearance is unmistakable and invariable, and could not 
occur in a body hung up after death, the secretion of saliva 
being a living act (Chevers, quoted by Husband). 

To determine the question whether the hanging was sui- 
cidal, homicidal or accidental, regard must be had to the 
attending circumstances; remembering always that hanging 
is a particularly frequent method of suicide. Out of 368 
cases of suicide occurring in Berlin, 189 resulted from 
hanging. Hence, the presumption is always in favor of 
suicide; besides the difficulties that would attend an attempt 
at murder by this means. If, however, the body exhibit 
evidences of great violence externally, denoting a struggle, 
or marks of the fingers about the throat, or of internal 
laceration, these would be more consistent with homicide. 
The position of the body will throw very little light upon the 
question, since it is fully demonstrated that complete suspen- 
sion is not necessary to produce death. In numerous 
instances the body has been found, after death, resting upon 
the knees, the toes, or the buttocks, or semi-recumbent, and 
in one case entirely supported by the bedstead, while the 
neck rested in a loop of leather. 



156 MEDICAL JURISPRUDENCE. 

Even if the hands and feet are found tied, the inference 
is not warranted that the act was homicidal, since deter- 
mined suicides have been known to perform this very act 
previous to hanging themselves. Nevertheless, if a person 
be found with his hands and feet tied, and suspended from 
a position which obviously he could not have reached 
himself, the presumption of homicide would certainly be 
justified. 

The age of the deceased might be supposed to assist in 
solving the question. If a very young person were discov- 
ered dead from hanging, it would naturally be attributed to 
homicide ; yet numerous instances have occurred in this 
country, within the last few years, of suicidal hanging of 
children not over twelve or fourteen years of age. 

Cases of accidejital hanging are of occasional occurrence, 
especially among children, who have, while swinging, or 
otherwise playing, accidentally become entangled in a noose 
or loop of cord, which was then drawn tightly enough 
around the neck to strangle them. 

SECTION IV. 
DEATH BY DROWNING. 

MODE OF DEATH IN DROWNING. — TIME REQUIRED. — SIGNS OF DEATH, 
EXTERNAL AND INTERNAL. — ACCIDENTAL, SUICIDAL AND HOMI- 
CIDAL DROWNING. 

Drow7iing is that special form of death by suffocation, in 
which the breathing is arrested by water, or some other 
liquid, and even more effectually than by a ligature drawn 
around the neck. It is not necessary that the whole body 
should be submerged in order to cause death by drowning. 
This may be accomplished by merely immersing the face, so 
as to keep the nose and mouth under the liquid, as is wit- 



DROWNING. 157 

nessed in the case of drunkards, epileptics and very young 
children falling with their faces into very shallow pools, and 
perishing from inability to extricate themselves. In drown- 
ing, in addition to the usual cause of death by asphyxia — 
the deprivation of air — there is superadded the physical 
impediment of the introduction of water into the minute air 
tubes and vesicles of the lungs by aspiration, in the violent 
efforts of the person to breathe. This is demonstrated by 
the experiments made by the Committee of the Medico- 
Chirurgical Society of London. Two dogs of the same 
size were submerged at the same moment, but one had his 
windpipe plugged, so as to prevent the ingress of both air 
and water, while the other had not. After two minutes they 
were taken out together ; the one with the windpipe plugged 
recovered at once on removing the plug; the other died. 
In three experiments, dogs with their windpipes plugged 
were kept under sn^X.^x four minutes, and recovered perfectly 
on being taken out (Report on Suspended Animation, Med. 
Chir. Trans., 1862, p. 449). On inspecting the bodies of the 
animals, the difference was at once manifest; in those that 
were simply deprived of air by plugging the windpipe, the 
lungs were congested ; but in those that had been sub- 
merged in their ordinary,condition, i. e. actually drowned, 
the lungs, besides being congested, exhibited in their bron- 
chial tubes and air vesicles a bloody, frothy mucus, which 
completely filled the air vesicles and small tubes, forming a 
mechanical impediment to the ingress or egress of air. The 
lungs were sodden with water, heavy, soft and doughy to 
the feel, and pitted on pressure of the finger. In the lungs 
of animals that recovered after a short submersion, very 
little, if any, of this mucous froth was found ; its amount 
was always proportionate to the time of submersion. There 
is no doubt that this froth is produced by the violent 



158 MEDICAL JURISPRUDENCE. 

efforts to breathe which are made within a minute after 
submersion. 

Hence, the probabihty of recovery after drowning is 
mainly dependent upon the quantity of this mucous froth 
existing in the air tubes and vesicles of the lungs, and also 
of the water that has penetrated into the substance of the 
lungs. If the quantity is large, the result is almost certainly 
fatal ; if it is small, there is always good hope of recovery. 
Asphyxia occurs in a minute, to a minute and a half after 
submersion. If the submersion has been complete for fotir 
minutes, the case may be considered hopeless, unless syn- 
cope had occurred at the moment of entering the water. 
This, by partially suspending the attempts at respiration, 
would undoubtedly tend to prolong life for some minutes 
longer. Cases are reported of resuscitation after being 
fifteen minutes under water; but these are exceptional. It 
should be remembered that the heart may continue to beat 
some minutes after respiration has ceased; but, in the 
present instance, the pulsation of the heart is no criterion of 
the power of recovery, on account of the physical impedi- 
ment in the lungs just alluded to. 

Dr. Taylor gives the following excellent resume of the 
circumstances attending on a case of drowning: "When a 
person falls into the water and retains his consciousness, 
violent attempts are made to breathe; at each time that he 
rises to the surface a portion of air is received into the 
lungs, but, owing to the mouth being on a level with the 
liquid, water also enters and passes into the throat. A 
quantity of water thus usually enters the mouth, which the 
drowning person is irresistibly compelled to swallow. In 
his efforts to breathe while his head is below the water, a 
portion of this liquid is drawn into the air-tubes and cells 
of the lungs. The struggle for hfe may continue for a 



SIGNS OF DROWNING. 159 

longer or shorter period, according to the age, sex and 
strength of the person, but the result is that the blood in 
the lungs is imperfectly aerated, the person becomes ex- 
hausted, and insensibility follows. The mouth then sinks 
altogether below the level of the water ; air can no longer 
enter into the lungs ; a portion of that which they contained 
is expelled, and rises in bubbles to the surface; an inde- 
scribable feeling of delirium, with a ringing sensation in the 
ears, supervenes ; the person loses all consciousness, and 
sinks asphyxiated. In the state of asphyxia, while the 
dark-colored blood is circulating, convulsive movements of 
the body take place, and the contents of the stomach are 
sometimes ejected by vomiting. There does not appear to 
be any sensation of pain, and, as in the other cases of 
asphyxia, if the person recovers, there is a total uncon- 
sciousness of any suffering " (Med. JiLvisp.^ Am. ed., p. 416). 

Even after resuscitation from drowning, death frequently 
takes place within a few hours or days, from secondary 
causes, as exhaustion, obstruction to respiration from the 
condition of the lungs, convulsions and spasm of the 
glottis. 

Signs of death by Drowning. — i. External. These vary, 
according to the length of time the body has been in the. 
water, and the interval after it was taken out. Supposing 
the immersion not to have been over two or three hours, 
and the inspection to be made immediately, the face will be 
found to be pale, the expression placid, the eyes half open, 
the eyelids livid, and the pupils dilated, the mouth half 
closed or open, the tongue swollen and congested, often 
indented by the teeth, and perhaps lacerated; the lips and 
nostrils covered with a mucous froth, which issues from 
them. The skin is cold and pale, and generally contracted 
so as to present the appearance of* goose skin " {cutis anse- 



160 MEDICAL JURISPRUDENXE. 

rina). This, being a vital act, is a pretty sure sign that the 
body was living when immersed in the water. It is not 
dependent on cold, as was at one time supposed. In males, 
the retraction of the penis is considered by Casper and Kanz- 
ler as a very positive sign of drowning. 

Besides the above, there are sometimes seen marks of 
abrasion on the body, especially on the hands, together with 
sand, gravel or mud under the nails, weeds, pieces of wood 
or other matters locked in the hands, all of which would 
seem to indicate that the person had been alive when first 
immersed in the water, although the abrasions might very 
possibly have resulted from the body rubbing against some 
rough substances after death. After several days' immer- 
sion, the palms of the hands and soles of the feet become 
white, thickened and sodden, the result of imbibition. 

If putrefaction has commenced before the body is removed 
from the water, the face will have assumed a reddish, or 
bluish-red coloration. 

2. Internal. — Along with the usual evidences of death 
from asphyxia (in an early examination), the following signs 
will be observed : the lungs are distended, overlapping the 
heart, and are in a flabby condition ; this latter is owing to 
the water taken in by aspiration, during the struggles for 
breath, which penetrates even the air vesicles, and renders 
them sodden and doughy. When cut into, the lungs exude 
a bloody, mucous froth. The prese7ice of this froth in the 
smaller tubes and air cells, together with the sodden condition 
of the lungs, is regarded as one of the most positive signs 
of death by drowning. Nevertheless, its absence should 
not be accepted as a proof against drowning, since it has 
not been found in the bodies of persons who have sunk at 
once in the water, and never risen to the surface to breathe. 
Dr. Ogston states that in 48.7 per Qcnt. of cases, no water 



SIGNS OF DROWNING. 161 

was found in the lungs, and he accounts for its absence by 
its transudation from the lungs into the pleural cavities, 
where it was found in quantities varying from one to thirty- 
four ounces. In a case examined by the author a year ago, 
of the body of a woman taken out of the river Delaware, 
there was an absence of this characteristic froth in the 
minute bronchial tubes, and also of the peculiar flabby con- 
dition of the lungs. The absence of these same peculiari- 
ties in the lungs of the deceased, in the late celebrated 
Jennie Cramer case, at New Haven, Ct., created a doubt in 
the minds of many that it was not a case of suicide by 
drowning, but that the girl was murdered before the body 
was thrown into the water. The fact of the discovery of a 
considerable amount of arsenic in the body of the deceased 
was, of course, sufficient to account for the death. We 
believe that these peculiar conditions of the lungs of the 
drowned have not yet been sufficiently determined. It is 
quite possible that some cases of bodies taken out of the 
water, and reported by coroners' juries as " found drowned," 
may in reality have met their death by other means, prior to 
their immersion. It is important to remember that the 
presence of this mucous froth in the air-passages is not seen 
after putrefaction, or after long exposure of the body to the 
air : this may account for the fact of its occasional non- 
observance in the bodies of the drowned. 

Another important indication of death by drowning is the 
presence of zvater in the stomach, which had been swallowed 
in the act of drowning, especially if this corresponds with 
the water in which the body was found. The value of this 
is enhanced, if, along with the water, there be discovered in 
the stomach fragments of weeds, sand, mud or other articles, 
corresponding with the hke substances existing in the pond 
or river where the drowning occurred. The quantity of 



162 MEDICAL JURISPRUDENCE. 

water in the stomach varies considerably ; it was found to 
be greater in an animal that was allowed to come to the 
surface frequently, than in one kept completely submerged, 
because in the latter the power of swallowing was sooner 
lost, in consequence of the early occurrence of asphyxia. 

The absence of water from the stomach is not to be con- 
sidered as disproving a case of drowning, inasmuch as it is 
not present (because not swallowed) in cases where either 
syncope or apoplexy had occurred at the moment of im- 
mersion. 

The mere discovery of water in the stomach is not of 
itself a positive indication of death by drowning, since it 
may have been swallowed before immersion; but with this 
allowance, and with the restrictions above mentioned, it 
does constitute a very important sign, inasmuch as it has 
been ascertained by experiment that water will not penetrate 
into the stomach after death, unless putrefaction has ad- 
vanced to a great extent; consequently, its presence indi- 
cates pretty certainly that it had been szvallowed in the act 
of drowning. Orfila's experiments prove that water may 
penetrate into the larger bronchial tubes after death, but not 
into the air vesicles of the lungs; besides, in such cases, 
there is no accompaniment of m.ucous froth in the air tubes. 

The condition of the heart affords no positive indication 
of death by drowning. In the majority of cases the right 
cavities are full, and the left ones empty, as in asphyxia gen- 
erally ; but very often the two sides are equally full. 

The brai7i exhibits no characteristic post-mortem sign. 
There may be some general fullness of the vessels, but 
never extravasation of blood, unless a sudden apoplexy 
had supervened, as when a person plunges suddenly into 
cold water after eating heartily, or by striking the head 
against a hard body, in the act of diving. The blood is usu- 



SIGNS OF DROWNING. 163 

ally dark and fluid. The mucous lining of the stomach and 
bowels is usually congested, and if the body had been long 
in the water, of a deep violet color; this might lead to the 
suspicion of irritant poisoning. Occasionally, in cases of 
drowning after a full meal, vomiting occurs, and the con- 
tents of the stomach are found in the windpipe and lungs; 
this is a conclusive evidence that the person must have been 
alive at the time. 

The time at which the bodies of the drowned will float 
varies with the temperature of the air, the water, the age, 
sex and corpulence of the person, etc. As the human body 
is slightly heavier than water, it must remain submerged 
until it becomes lighter, through the development of the 
gases of putrefaction. Hence, in summer, the body may 
rise within twenty-four hours. In salt water, it will float 
sooner than in fresh ; very fat bodies float sooner than lean 
ones ; the bodies of women sooner than those of men. 

To determine the time that has elapsed since the act of 
drowning, when the body is discovered in the water, is not 
always possible. After putrefaction has set in, it is altogether 
mere guesswork. The most certain criteria to guide the 
examiner are the presence of the mucous froth in the air 
tubes and cells, and the presence of water in the lung tissue, 
both of which indications disappear after long exposure to 
the air, and after putrefaction. Hence, the importance of an 
early inspection. 

If marks of violence be found on the bodies of the 
drowned, of course, suspicion will be aroused of foul play, 
unless these marks can be satisfactorily attributed to some 
post-mortem cause. A murderer may destroy his victim, 
and then throw the body into the river, pond, or well, with 
the intention to elude suspicion of the real cause of death. 
A close examination of the body for wounds, and other 



16i MEDICAL JURISPRUDENCE. 

injuries, together with the absence of the known signs of 
drowning, will generally enable the examiner to form a 
correct conclusion. This is a very common method of 
disposing of the bodies of new-born infants, in cases of 
infanticide. 

The question of accident, homicide or suicide, in the case 
of drowning, must claim the attention of the legal physi- 
cian. Ho7nicidal drowning is rare, except in the case of 
infants. It is denoted by the marks of violence on the 
body, which cannot be explained by any post-mortem influ- 
ence. It should be remembered that determined suicides 
frequently inflict dangerous wounds upon themselves, and 
then terminate their lives by drowning. Such cases might 
possibly be mistaken for homicide. The presence of the 
usual signs of drowning would at least show that the body 
was alive at the time of immersion. Suicidal and accidental 
drowning cannot always be distinguished from each other ; 
inferences may, however, be drawn from the circumstances 
attending the cases, as the existence of a motive to suicide, 
or a tendency thereto; the proximity of a precipice, or other 
dangerous place, to the water in which the deceased was 
found would naturally suggest accident^ especially in the 
case of a child. The tying of the hands and feet of a per- 
son found dead in the water is no proof of homicide, since 
many instances are recorded of suicides binding themselves 
in this same manner, and also of attaching heavy weights 
to their bodies before throwing themselves into the water. 

The restoration of the drowned depends chiefly on exciting 
artificial respiration. The clothes should be immediately 
removed, and the body quickly wiped dry and wrapped in a 
blanket; clear the mouth and nostrils of mucus and water; 
draw forward the tongue ; place the body with the face down- 
ward, the forehead resting on one arm, for a few moments. 



RESUSCITATION OF THE DROWNED. 165 

to allow the fluids to run out of the mouth; apply ammonia 
cautiously to the nose. If respiration is not restored, place 
the body on the back, with the head raised, and adopt Syl- 
vester's process of artificial respiration, by carrying the arms 
gently outward and upward above the head, for a few 
seconds : this movement expands the chest. Then lower 
the arms, and bring them to the sides of the chest : by this 
action, expiration is effected. These alternate movements 
should be made each about every two seconds. All rough 
handling, such as the absurd, vulgar plan of rolling on a 
barrel, should be avoided. As soon as any signs of respira- 
tion are manifested, warmth should be applied to the skin 
by a warm bath, or stimulating friction. When able to 
swallow, the patient may take a little warm spirit and water, 
and then be put to bed and allowed to sleep. This treat 
ment has been rewarded with success after being persisted 
in for some hours. 



1G6 MEDICAL JURISPRUDENCE. 



CHAPTER X. 

DEATH BY LIGHTNING. 

MEDICO-LEGAL RELATIONS OF DEATH FROM LIGHTNING. — MODE OF 
DEATH. — POST-MORTEM SIGNS. 

Death caused by Lightning is often accompanied by 
results which resemble very strongly the effects of homi- 
cidal violence. The subject should, therefore, claim the 
attention of the legal physician, inasmuch as he may be 
called upon to determine the cause of death in an un- 
known case, when the body has been discovered in a 
remote and solitary situation, and bearing upon it marks 
of severe external injury. 

The destructive effects of lightning exactly resemble 
those of a powerful electric battery, thus demonstrating the 
identity of the two forces. In a thunder-storm the electric 
condition or polarity of the cloud is nearly always positive, 
while that of the earth immediately beneath it is negative. 
When these polarities become intensified by mutual induc- 
tion, the disruptive discharge ensues through the air, or any 
other body that may happen to intervene — the human body, 
for example. 

The only rational explanation of the fact that more men 
than women are killed by lightning is, that the former, from 
the nature of their employments, are mostly out of doors, 
and are, therefore, more exposed to the danger. Experi- 
ence proves that persons in the open fields, especially under 
trees, are much more liable to be struck by lightning than 
those within doors. 

The fatal effects of lightning are usually instantaneous. 



DEATH BY LIGHTNING. 167 

death being caused by shock. At times, however, it pro- 
duces lesions of the brain and spinal cord, such as epilepsy, 
paralysis, effusion of blood, tetanus, etc., which may subse- 
quently prove fatal. Generally speaking, if death does not 
follow im mediately, or soon after, there may be hopes of 
recovery. 

The visible effects produced by a fatal lightning-stroke 
are remarkably varied. Sometimes, a deep, punctured or 
lacerated wound will indicate where the fatal blow was 
struck, upon the head, neck, or other part of the body ; the 
hair may be singed, or burnt off; the clothing may be burned, 
or completely stripped off; the boot may be split open. 
Again, the course of the electric current may be marked 
by a deep, or superficial burn, extending from the point of 
entrance, doAvn and around the body, to the ground. If 
there should happen to be any metallic substances in con- 
tact with the body, such as chains, coins, a watch, etc., as 
these are good conductors of the electric current, it will be 
certain to include them in the circuit, and they will be fre- 
quently found to have been melted. 

In other cases of death by lightning, no external wound 
or burn may be visible. Sometimes there may be severe 
external injuries, while the clothes entirely escape. Again, 
the clothing may be completely torn off the body, while the 
latter exhibits no injury whatever. 

The capricious action of the discharge is shown by the 
fact that out of a party of three or four sitting under a tree, 
one or two only may be killed, and the others escape. 
Again, it has occurred that persons under a low tree have 
been struck, although high trees, and a lightning rod, and 
an iron bridge were near (Tidy). Again, the same dis- 
charge may produce in one person wounds, and burns in 
another. The diversity of its action on the clothes may 



168 MEDICAL JURISPRUDENCE. 

probably be explained by the circumstance of a portion of 
the clothing- being wet, and a portion dry: the former, 
being a good conductor, might escape the disruption which 
would be exhibited by the dry portion, which is a bad 
conductor. 

Post-mortem appearances. — In case of instantaneous 
death, the body may be found in the exact attitude in which 
it was struck. Some remarkable instances of this are 
recorded in the books. In such cases, the rigor-mortis 
occurs immediately after death. Hunter supposed that 
there was an absence of the usual rigidity after death, but 
in this he was in error. Coagulation of the blood also 
occurs, although it is delayed. The face is often bloated 
and discolored; and putrefaction is usually very rapid. 
Wounds of various characters are observed — contused, 
lacerated and punctured ; also burns, vesications and 
ecchymoses; these latter sometimes exhibit a remarkable 
arborescent appearance. Occasionally, fractures of the 
skull and of other bones are noticed. The blood is dark 
and fluid. 

The brain and its membranes generally suffer most 
severely, the head being usually the part first struck. Con- 
gestion of the brain, effusion of blood under the skull and 
into the ventricles, and even complete disorganization of the 
brain substance, have all been observed. The lungs are 
sometimes found congested and injured, and the air tubes 
full of mucus. The stomach, intestines, liver and spleen, 
are also usually much congested. The heart does not ex- 
hibit any special alteration. 

The medico-legal interest, in cases of death from light- 
ning, is centered in the question of being able to identify 
such cases, and to distinguish them from those of homicidal 
violence. A close observation of all the circumstances of 



DEATH BY LIGHTNING. 169 

the case — such as the occurrence of a thunder storm about 
the time of the death, the pecuHar appearance of the 
wounds and burns, especially if the two co-exist on the 
same body, the half-melted appearance of metallic articles, 
such as buttons and coins, on the person of the deceased, 
etc. — will tend to throw much light upon it. 



170 MEDICAL JURISPRUDENCE. 



CHAPTER XL 

DEATH FROM HEAT AND COLD. 

DIVERSE EFFECTS OF HEAT UPON THE BODY. — POST-MORTEM APPEAR- 
ANCES. — EFFECTS OF COLD. — POST-MORTEM SIGNS. 

The effects of extreme heat on the human system are 
familiarly witnessed in tropical and semi-tropical climates, 
during the heated term, in the mortality arising from what 
is popularly denominated sunstroke. In such cases, the 
dangerous and fatal results are attributable directly to solar 
heat. But effects equally serious are known to be produced 
by exposure to artificial heat, if too long continued, as is 
witnessed in the employes in engine-rooms, factories, etc., 
where a very high temperature is habitually maintained. 
There would seem to be, according to the observations of 
Dr. H. C. Wood {Phila. Med. Times, 1876), three distinct 
conditions of the human body occasioned by excessive heat, 
in the first (which is rare), we have acute meningitis or 
phrenitis {coicp-de-soleil) ; in the second, we have heat- 
exhaustion with collapse, accompanied by a rapid, feeble 
pulse, a cool, moist skin, and a tendency to syncope; in the 
third, we have true thermic fever — that condition which 
results especially from exposure to artificial heat. But 
something more than mere heat is required to produce 
thermic fever. It does not occur in a perfectly pure and 
dry atmosphere, because the profuse perspiration which is 
immediately developed by its rapid evaporation keeps the 
temperature of the body down nearly to the normal 
standard. If, however, the air is already saturated with 



EFFECTS OF HEAT AND COLD. 171 

moisture, this will prevent the evaporation from the body, 
and its temperature will rise to a dangerous height. 

The symptoms vary in intensity, from a mere headache 
with drowsiness, to complete insensibility, coma, and para- 
lysis. In many instances, death appears to be caused by 
paralysis of the heart. 

The post-mortem appearances are by no means constant. 
In some cases (true coitp-de-soleit) we find decided conges- 
tion of the brain and its membranes, with serum in the 
ventricles, together wnth congestion of the lungs and of the 
abdominal viscera generally; and the heart, as in ordinary 
death from asphyxia. In other cases, there is anaemia of the 
substance of the brain, along with distention of the larger 
vessels with dark, fluid blood, but the minute vessels 
empty. 

Cases of insolation do not often claim the attention of the 
legal physician, yet as they might occur remote from wit- 
nesses, and with a fatal termination, it is proper that the 
medical examiner should understand their nature, together 
with the ordinary accompaniments. 

The effects of cold upon the animal body are immediately 
depressing, but if it be of short duration, and the system is 
healthy, reaction takes place and stimulation follows. The 
healthy human body has the power to maintain its normal 
temperature of about 98.6° F. independently of the external 
temperature. It has been ascertained by actual experiment 
that a warm-blooded animal will not survive if its tempera- 
ture is reduced down 16 to 20 degrees below the normal. 
There is no authentic account of the recovery of a warm- 
blooded animal, much less a human being, after the whole 
body was frozen, although fishes and other of the lower 
animals are said to have been resuscitated from a frozen 
state. 



172 MEDICAL JURISPRUDENCE. 

Death from cold is hastened by whatever exhausts the 
system, as fatigue, both bodily and mental, loss of rest, want 
of proper food and nourishment, mental depression, and par- 
ticularly intoxication. A damp cold (such as wet clothing) 
is more dangerous than a dry one. The fatal effects of ex- 
posure to cold are witnessed, even in comparatively tem- 
perate climates during the winter, in the cases of the desti- 
tute, and especially where this condition is associated with 
intemperance. 

Cases of death from cold do not often require the atten- 
tion of the medical jurist. There are, however, certain con- 
ditions under which they may occur, which demand a brief 
consideration. 

A not infrequent form of infanticide is the exposure of a 
new-born child to the extreme cold air. Death will soon 
ensue under such circumstances, since the infant's power of 
resistance to cold is extremely limited. In such a case it 
will be the physician's duty to examine the body of the 
child, and consider the circumstances of the case, such as 
the place where it was found, the temperature of the air, the 
possibility of its being accidental, etc. As regards the body^ 
he should notice if the pallor is extreme ; if frozen stiff, he 
should distinguish this rigidity from rigor mortis; the ar- 
terial color of the blood; the accumulation of blood on both 
sides of the heart and in the larger vessels. There may 
also be marks of violence upon the body. 

Occasional instances of the exposure of young children 
to cold with homicidal intent, are recorded. Such a case 
is related {Ami. d'Hyg., 9, 183 1, p. 207), of two inhuman 
parents causing the death of a daughter, aged eleven years, 
by compelling her to get out of bed on a very cold night, 
and place herself in a vessel of ice-cold water. 

In the treatment of the insane, the barbarous and im- 



COLD POST-MORTEM SIGNS. 173 

proper use of the cold shower bath, for reducing intractable 
patients to submission, was formerly much more in vogue 
than at present. It need hardly be said that such treatment 
is extremely hazardous, and it has been followed by fatal 
results. Dr. Taylor records an instance of a lunatic, aged 
sixty-five, who was subjected to the cold shower, at 45° F., 
and who afterwards took a dose of tartar emetic ; he died 
in fifteen minutes subsequently. Cases of this character 
would very properly come under the notice of the legal 
physician, and the authors of such treatment would be 
justly liable to indictment for manslaughter. 

Post-mortem appearances. — These cannot be considered as 
very characteristic ; hence, the examiner should be cautious 
in deciding, in any given case, as to whether exposure to cold 
was the primary cause of death. All the circumstances of 
the case here require special consideration, such as the 
season of the year, the temperature of the air, the place of 
exposure, etc. Rigor mortis generally sets in slowly, and 
lasts a long time. According to Dr. Ogston {Brit, and For. 
Med.-Chir. Review^ 1855), the four following appearances, in 
the absence of any other obvious cause, would justify the 
conclusion that the death had resulted from cold, although 
the signs were not so well marked in children as in 
adults : — 

(i) An arterial hue of the blood, except when viewed 
in mass within the heart ; some exceptions are, however, 
noted. 

(2) An unusual accumulation of blood on both sides of 
the heart. 

(3) Pallor of the general surface of the body, and con- 
gestion of the viscera most largely supplied with blood. In 
some cases the congestion of the brain and liver was only 
moderate. 



174 MEDICAL JURISPRUDENCE. 

(4) Irregular and diffused dusky-red patches on limited 
portions of the exterior of the body, even in non-dependent 
parts (distinguishing them from suggillations). 

As putrefaction does not occur at a freezing temperature, 
the discovery of a decomposing corpse in the ice or snow 
would afford a very strong, though not absolutely conclus- 
ive, evidence that the death was not the result of exposure 
to cold, but rather that the body had been frozen after death. 



DEATH BY STARVATION. 175 



CHAPTER XII. 

DEATH BY STARVATION. 

ACCIDENTAL, HOMICIDAL AND SUICIDAL STARVATION. — PRETENDED 
CASES OF VOLUNTARY STARVATION. — SYMPTOMS AND POST-MORTEM 
SIGNS. — MEDICO-LEGAL RELATIONS. 

Cases of death by Starvation are of sufficiently frequent 
occurrence to merit the notice of the medical jurist. Acute 
starvation implies the sudden and complete deprivation of 
all food. Chronic starvation is the result of a continued de- 
ficient supply of food, both in quantity and quality. Homi- 
cidal death from acute starvation is very rare, but cases of 
accidental death from this cause are sufficiently numerous, 
as in the instances of miners buried in the earth, shipwrecked 
mariners, and others cut off from food. Occasionally, pris- 
oners and lunatics will undertake to commit suicide by vol- 
untary abstinence from all food; in the great majority of 
cases, however, their courage fails them after some days' ex- 
perience, and they give up the attempt. 

The many notorious cases of voluntary fasting which have 
claimed the notice of the public during the past years, have 
proved, on close investigation, to be deceptions, food and 
drink having been supplied surreptitiously to the individuals 
concerned. Among these instances may be mentioned the 
case of Ann Moore, of Tetbury, England, who was alleged 
to have abstained from all food from 1807 to 181 3. Another 
case was that of the Welsh Fasting Girl, aged thirteen years, 
who is stated to have absolutely fasted for two years. Both 
these cases were shown to be impostures. The notorious 
Dr. Tanner, of our own country, undertook, for a considera- 



176 MEDICAL JURISPRUDENCE. 

tion, to perform the feat oi^^ forty days' absolute fast, in New 
York, in August, 1880, and, to all appearance^ he accom- 
plished it ! It is stated that during all this time, he absolutely 
partook of nothing, save some ounces of pure water, each 
day ; and that his loss of weight at the end of forty days 
was thirty-six pounds. The fluctuations in his pulse, tem- 
perature and respiration were unimportant. This case was 
not under very strict medical supervision, and there is doubt 
about its perfect genuineness; this would seem to be con- 
firmed by the fact of his voracious appetite on the comple- 
tion of the fast, unattended by any bad effects, which is con- 
trary to the general experience of others who have been 
deprived of food for a length of time. 

Chronic starvation^ as the result of disease, is a frequent 
cause of death, as is witnessed in stricture of the oesopha- 
gus, cancer and other disorders of the stomach and bowels, 
disease of the pancreas, marasmus, etc. It is likewise the 
cause of disease and death in young children fed upon 
unhealthy milk (either from the nurse or cow), where this 
fluid is deficient in some of its proper constituents, thereby 
causing defective nutrition. Such cases are abundantly 
illustrated in the miserable victims of baby-farming. It is 
also witnessed on a large scale in districts of country where 
famine has prevailed, as in certain parts of India, and in the 
Irish famine of 1847. 

The symptoms of chronic starvation are generally well-, 
marked. The sense of hunger is not very urgent ; emacia- 
tion, especially in the last stage, is extreme ; the eyes are 
hollowed, the pupils dilated; the skin is harsh and dryland 
hangs loosely over prominent bones, and, in chronic cases, 
becomes covered with a brownish, dirty-looking coating, 
and exhales an offensive odor, like that of putrefaction. 
The bowels are either very constipated, or the fseces are 



STARVATION. 177 

scanty, dry and dark colored. There is great muscular 
debility, palpitation, with tinnitus auriuin\ pains in the 
stomach, with a dry, parched mouth ; the intellect some- 
times clouded, but again clear to the end, with despond- 
ency of mind. The pulse is at first somewhat quickened, 
afterward it is slower; the temperature is usually below 
that of health. 

Post-mortem appeara7ices. — Great emaciation of the body, 
with an almost entire loss of fat. The skin shriveled, and 
emitting a disagreeable odor. The muscles soft, pale and 
wasted. The brain sometimes congested, and at others pale 
and soft, with effusion of serum on the surface, and in the 
ventricles; the lungs healthy, or anaemic; the heart more 
or less contracted, and void of blood ; stomach and intes- 
tines contracted, thin and transparent, the latter usually 
empty ; the bladder contracted and empty. 

As regards the medico-legal relations of starvation, 
although it is rarely the cause of homicidal death, it should 
be remembered that the law does not require the absolute 
deprivation of food to be proved, but only the necessary 
quantity and quality to be withheld, provided this has been 
done with an evil intention. 



178 TOXICOLOGY. 



CHAPTER XIII. 

DEATH FROM POISONING. 
(TOXICOLOGY.) 

Poisojiing is the most frequent of all the causes of violent 
death (the casualties of war excepted), as is shown by the 
statistics of different countries. The facility with which 
poisons may be procured, the ease with which they can be 
administered, and the close resemblance that many of them 
bear to disease in their symptoms and post-mortem lesions, 
will account for the fact of their extensive employment, both 
for homicidal and suicidal purposes. 

The science of Toxicology^ which treats of the nature, 
symptoms, effects, doses and modes of detection of poisons, 
is very properly included in a treatise on Medical Jurispru- 
dence; and since, as already remarked, so large a proportion 
of violent deaths is to be ascribed to poisoning, it is import- 
ant that the medico-legal student should be properly in- 
structed in this branch of the subject. 

SECTION I. 

DEFINITION OF A POISON. — EFFECTS. — PROOFS OF ABSORPTION. — 
SUBSEQUENT DISPOSITION OF THE POISON. — ELIMINATION. — HOW 
DO POISONS CAUSE DEATH? — CIRCUMSTANCES MODIFYING THEIR 
ACTION. — ANTAGONISM OF POISONS. 

A Poison is a substance which, when introduced into the 
body by swallowing, or by any other method, occasions 
disease or death ; and this as an ordinary result, in a state 
of health, and not by a mechanical action. It must be as 
an ordijiary result: a substance, for example, which affects 
one person injuriously, through idiosyncrasy ^\?> not a poison. 



EFFECTS OF POISONS. 179 

Again, it must be in the healthy system : many diseases render 
the system extremely susceptible to impressions by external 
agents ; e. g., in gastritis, the blandest substance — even 
water — may excite vomiting. Again, the substance must 
not act mechanically : thus, powdered glass, fragments of 
iron, etc., may produce death when swallowed, yet these 
cannot be regarded as poisons. 

According to the above definition, it matters not by what 
avenue a poison gains access into the body, its ultimate 
effects are the same. The stomach, of course, is the most 
usual means ; but the rectum, the skin, the lungs, and the 
cellular tissue by hypodermic injection, and even the nose, 
ear, and vagina are also channels of entrance. Inhalation 
of poisonous vapors through the lungs, and the subcuta- 
neous introduction by the hypodermic syringe, affect the 
system far more rapidly than by swallowing. 

The mere size of the dose constitutes no distinction, 
legally, between a poisonous and a non-poisonous sub- 
stance; thus, half a grain of strychnia, or half an ounce of 
oxalic acid, may be the quantity which proves fatal. 

The Effects of Poisons are local and remote. The local 
effects are the direct impressions produced on the part of 
the body with which the poison comes into contact, e. g.y 
the corrosion of the stomach and bowels by the immediate 
contact of the mineral acids and alkalies. Often a poison 
may act both locally, by its causing inflammation of the 
stomach, and also remotely, on the brain and nervous 
system. Arsenic frequently acts in this twofold manner. 

The remote effects of a poison are those results which are 
produced on parts of the system remote from that to which 
it was first applied. These remote effects constitute, in fact, 
the M^wA symptoms of poisoning — one very important factor 
in the diagnosis of the case. 



180 TOXICOLOGY. 

Mode of Action of Poisons. — In order that a poison 
should produce its pecuHar effects on the system, it is 
necessary (except in the case of corrosives) that it should 
get into the circulation, so as to be conveyed to distant 
parts of the body; and for this purpose it must first be 
absorbed. Although other modes of transfer of the poi- 
sonous impression to remote parts of the system have 
been, at various times, recognized— such as nervous com- 
munication, and contiguity of structure — the present accepted 
doctrine is that of absorption into the circulation. 

The proofs of absorption are abundantly afforded, (i) by 
the detection of poisons in the blood ; (2) in the secretions, 
especially the urine ; and (3) in the different viscera of the 
body, as the liver, kidneys, lungs, spleen, brain, etc. An 
essential part of the duty of the toxicologist is not merely 
to discover the poison in the stomach of the deceased (since 
that might possibly have been introduced after death), but 
to detect it, in the absorbed state, in the viscera. 

The rapidity of absorption is materially influenced (i) by 
the solubility of the poison ; (2) by the nature of the surface 
to which it is applied, it being in direct ratio to the vascu- 
larity of the part. It is for this reason that the most rapid 
absorption is from the air-cells of the lungs, when the sub- 
stance is inhaled in the form of vapor. For this same 
reason, also, when it is injected directly into the blood 
vessels, the effect is almost instantaneous. Certain animal 
poisons, such as the virus of glanders, syphilis, smallpox, 
etc., whe7i swallowed, appear to undergo a change, through 
digestion, which renders them innocuous. The absorption 
of poisons from the stomach is modified by the full or empty 
condition of that organ — being most rapid when it is empty. 
The sound ski?t may sometimes become the avenue for the 
introduction of poisons, as witnessed in the absorption 



DISPOSITION OF THE POISON. 181 

of arsenic, tartar emetic, corrosive sublimate and opium, 
when applied to that surface. By removing the cuticle, the 
absorption is much more rapid, as seen in the endermic 
method. (3) Fullness of the blood vessels. The rapidity of 
absorption is inversely to the quantity of the circulating 
fluid; hence, depletion by bleeding or purging will favor 
absorption. 

Subsequent disposition of the Poison. — After absorption 
into the blood, as it passes through the different organs, a 
portion of the poison is immediately separated by these, and 
is at once eliminated by the various secretions, as the bile, 
urine, saliva, pancreatic fluid and sweat. Another portion 
is temporarily deposited in the organs and tissues, and 
usually in the following order, as to quantity : the liver, 
spleen, kidneys, heart, lungs, brain, pancreas, muscles and 
bones. To this order there may be occasional exceptions, 
as some recent experiments seem to prove that lead and 
certain other mineral poisons show an especial affinity for 
the spinal marrow and brain. Only a minute quantity of 
the poison is circulating in the capillaries at any one time ; 
yet there is good reason to believe that it is exclusively this 
portion which is really noxious; while still remaining in the 
stomach, or retained in the organs, it is harmless. Hence, 
it is a common mistake to attribute death to the actual 
quantity of the "poison found in the stomach of the deceased; 
this is only the surplus, or complement of what was neces- 
sary to kill. Although that portion of the poison which is 
retained in the organs (absorbed) is, for the time being, 
innocuous, yet, as it is liable to be reabsorbed into the 
circulation, it may again prove active. 

While we have no positive proof that all poisons are 
deposited in the organs, we know that this is true of the 
mineral, and of some of the vegetable poisons. The gaseous 



182 TOXICOLOGY. 

poisons appear to be eliminated by the lungs immediately, 
without this deposition. This was proven by Bernard's ex- 
periments with sulphuretted hydrogen on dogs {Legons,^^. 59). 
The time required for an absorbed poison to be removed 
from the circulation, either by elimination or by deposition 
in the organs or tissues, varies for different substances, and 
also, probably, for different conditions of the system. Cer- 
tain medicinal substances are known to appear in the urine 
a few minutes after being swallowed, e. g. iodide of potas- 
sium and turpentine. In relation to mineral poisons, there 
is reason to believe that they are rapidly separated from the 
blood. Experiments have shown that arsenic may be dif- 
fused throughout the body of an animal in an hour and a 
half after being swallowed. It has also been found in the 
urine of a horse within one hour after administration. Prof 
Taylor found arsenic in the human liver four hours after 
being swallowed. Doubtless, it reaches this organ much 
sooner, although no opportunity has as yet been afforded of 
proving the fact, since death rarely occurs sooner than the 
above period. Taylor believes that the liver acquires its 
maximum of saturation by arsenic in fifteen hours after 
being swallowed. He gives a table of the estimated aver- 
age amount of this poison that will be found in this organ 
at different periods : In five to seven hours after taking, the 
quantity is 0.8 grain; in nine hours, 1.2 grains; in fifteen 
hours, 2.0 grains ; in seventeen to twenty hours, 1.3 grains; 
in fourteen days, 0.17 grains. It is generally admitted that 
arsenic is entirely eliminated from the human system in 
about fifteen days ; but cases have been reported where the 
poison was detected in the urine as late as the twenty-fifth 
day. As a rule, the analyst need hardly expect to find any 
traces of arsenic in the body of a person who has survived 
fifteen days. 



CIRCUMSTANCES MODIFYING POISONS. 183 

Other mineral poisons require a longer time for their 
elimination from the human body. According to M. L. 
Orfila, arsenic and corrosive sublimate require thirty days ; 
antimony, four months; silver, five months; lead and cop- 
per, over eight months. (Tardieu sur V Empoison., p. 19.) 

The mode of death by poisons has been a subject of much 
discussion. It must be admitted that we are not in posses- 
sion of the full explanation of this subject. We know that 
the various poisons circulate through the blood, and thus 
come in contact with the different organs, and then produce 
their specific effects — one, as opium, on the brain, causing 
narcotism; another, as prussic acid, on the heart, producing 
asthenia; a third, as strychnia, acting on the spinal cord, 
causing tetanus, etc.; but why they possess this elective 
affinity for different organs, we are unable to explain. Neither 
do we understand why different poisons exhibit a similar 
election in their modes of elimination from the system, e.g. 
iodide of potassium passing out, by preference, through the 
urine; mercury, by the saliva; arsenic, by the glands of the 
stomach, etc. 

It has been supposed by some that the poison produces 
some chemical alteration in the bloody thereby rendering it 
unfit for life. This, however, cannot be proved, although it 
is true that some poisons, when introduced into the circu- 
lation, do undergo a chemical change, as chloroform into 
formic acid, and the salts of the vegetable acids passing out 
through the kidneys as carbonates ; so, also, a combination 
of emulsin and amygdalin, when injected into the blood, re- 
sults in the production of prussic acid. This, however, fails 
to explain the true modus operandi of poisons. 

Modifying circumstances connected with poisons. — Some 
of these relate to the poison itself, and others are connected 
with the system. Among the former, the dose, and mode of 



184 TOXICOLOGY. 

administration require notice. As a rule, the larger the dose 
the more speedy the action. An exception to this is seen 
in the case of some irritants, such as arsenic, where a large 
dose may be rejected by vomiting, and might thus prove 
innocuous, whilst a smaller one would be retained. The 
efifect of some poisons is much modified by the dose; thus, 
a large dose of oxalic acid kills almost immediately by 
shock, while a smaller one will act upon the heart and ner- 
vous centres, and prove fatal later. 

The effect of combination of poisons is sometimes to in- 
crease, sometimes to diminish, their activity, and again, 
to antagonize, or neutralize their action. According to 
Christison, the effects of arsenic are decidedly modified by 
intoxication, which seems in some way to arrest or suspend 
its action. This is also probably true of other irritant 
poisons. The same authority mentions a case where a very 
large dose of corrosive sublimate and laudanum was taken, 
and there was a remarkable postponement of all the usual 
symptoms. 

The question of the Antagonism of Poisons — that is, 
whether, by a combination of poisons, their action upon 
the human system will become so modified as to conceal 
the symptoms, and prevent their discovery after death by 
the usual chemical tests — is one of considerable medico- 
legal importance. This doctrine was for the first time, we 
believe, in this country, urged with some apparent plausi- 
bility at the celebrated trial of Dr. Paul Schoeppe, at Carlisle, 
Pa., in 1869. After the failure by the prosecution to estab- 
lish the allegation of poisoning by prussic acid, it set up the 
claim that the death was produced by a mixture of this 
poison and morphia, and ascribed the absence of all the 
usual symptoms of prussic acid poisoning, and the failure to 



ANTAGONISM OF POISONS. 185 

detect either it (except by the merest trace, which was shown 
might result from the faulty method of the analysis) or the 
morphia, to the alleged antagonism of the two substances ! 
In the year 1870, the author made a number of experi- 
ments upon dogs, with a view of determining this question. 
A few of the results will be briefly detailed here. 

(i) Morphia and' Priissic Acid. — If both poisons were 
given in full lethal doses, the symptoms of both toxic agents 
were exhibited. The morphia never counteracts the fatal 
effects of the prussic acid, if the latter be taken in full 
poisonous doses. 

(2) Morphia and Atropia. — The mutual antagonizing in- 
fluence of these two alkaloids is now fully recognized in 
the human subject ; but it is less manifest in dogs. 

(3) Strychnia and Prussic Acid. — These powerful poisons 
evince no real antagonism. When both were taken in full 
doses, the usual symptoms of each were exhibited alter- 
nately — ordinary convulsions and tetanic spasms. 

(4) Strychnia and Morphia. — These alkaloids show no 
disposition to antagonism, when given in full doses. The 
narcotism of the morphia (taken first) was speedily followed 
by the tetanus of the strychnia (taken afterwards). 

(5) Atropia andEserine. — The investigations of Dr. Frazer 
with these substances, on dogs (Trans. Roy. Soc. Edin., Vol. 
XXVI), demonstrate a real antagonism, which was con- 
firmed by the author's experiments. 

(6) Atropia and Strychnia. — There would seem to be a 
true antagonism between these two alkaloids, sufficient to 
justify a resort to the use of atropia in a case of strychnia- 
poisoning. 

There also appears good reason for admitting the an- 
tagonism between Aconite and Digitalis — sufficiently so to 
warrant a trial of digitalis in a case of poisoning by 

9* 



186 TOXICOLOGY. 

aconite. (On the Antagonism of Poisons, Am. Jour. Med. 
Sci, 1 87 1.) 

The conditions of the system that modify the action of 
poisons are, habit, idiosyncrasy, and disease. Habit usually 
diminishes the power of poisons, as shown especially in the 
case of the narcotics opium and alcohol. It is also alleged 
to be true in the case of arsenic, as seen in the arsenic-eaters 
of Styria, and other mountainous countries. 

The effect of disease in modifying the action of poisons 
is witnessed in the tolerance by the system of opium in te- 
tanus and mania-a-potu ; and of its increased susceptibility 
to this drug in apoplexy and inflammation of the brain. In 
paralysis, the susceptibility to the action of strychnia is 
diminished. 

The influence oi sleep is usually to diminish, or retard the 
action of poisons. This is true of arsenic and the irritants 
generally. The narcotism produced by opium seems to 
produce a similar effect, and also to mask their symptoms. 

SECTION II. 
EVIDENCES OF POISONING. 

I. EVIDENCES FROM SYMPTOMS. — 2. FROM POST-MORTEM LESIONS. — 
3. CHEMICAL ANALYSIS. — POST-MORTEM IMBIBITION OF POISONS. — 
RULES IN PERFORMING A TOXICOLOGICAL ANALYSIS. — 4. PHYSIO- 
LOGICAL EXPERIMENTS. — 5. CIRCUMSTANTIAL EVIDENCE. — MEDICO- 
LEGAL CONCLUSIONS. — CLASSIFICATION. 

A knowledge of the evidences of poisoning constitutes 
the chief business of the toxicologist. It is by this ir.eans 
that he reaches a definite conclusion in the cases submitted 
to his investigation. These evidences comprise: (i) those 
derived from the Symptoms ; (2) those obtained from the 
Post-mortem appearances ; (3) those afforded by Chemical 



SYMPTOMS OF POISONING. 187 

analysis ; (4) those derived from Experiments on animals ; 
(5) the Moral or Circumstantial evidences. 

I. Evidences afforded by Symptoms. — These constitute a 
very important factor in the diagnosis of poisoning, but 
alone, they can never be sufficient to estabHsh the charge, 
for the reason that there are no characteristic symptoms of 
any poison; if this were possible, there would be no need of 
ever making a chemical examination, since the symptoms 
alone would be sufficient to decide the case. 

The first of these symptoms to notice is their sudden oc- 
currence in a perfectly healthy person, soon after taking food 
of drink. Most poisons produce their effects very soon after 
their administration — some of them almost immediately. 
But if given in very small quantities, and at intervals, as in 
slow poisoning, the symptoms may come on gradually, and 
be readily mistaken for disease. The physician should be 
extremely cautious about mentioning his suspicions of poison 
in a case of this character, before he has analyzed the sus- 
pected food and drink, and especially the urine of the pa- 
tient. 

The suspicion is strengthened, if several persons, after 
partaking of the same food, are suddenly seized with the 
same severe symptoms. But even here it might happen 
that some disease, like cholera, may have simultaneously 
attacked several persons, after partaking of a meal. Taylor 
mentions an instance of this character, occurring in London, 
where three, out of four members of a family, under suspi- 
cious circumstances, were suddenly seized with violent 
symptoms, which proved to be malignant cholera, which 
was prevailing at that time. 

A third feature connected with the symptoms is their 
rapid course toward a fatal termination. This, however, is 



188 TOXICOLOGY. 

not of much practical value, since the most active poisons 
do not always prove fatal immediately, while, on the other 
hand, many diseases run their course very rapidly. 

From what has just been said about symptoms, it will be 
readily understood that the practical difficulty consists in 
distinguishing between these, and the symptoms of disease. 
We shall, therefore, briefly consider those diseases whose 
symptoms most resemble the signs of poisoning. 

The disorders which most simulate irritant poisons are 
cholera morbus, malignant cholera, gastro-enteritis, perito- 
nitis, ulceration of the stomach, ilius, and hernia. Those 
which most resemble narcotic poisoning are apoplexy, 
epilepsy, inflammation of the brain, tetanus and cardiac 
diseases. 

Cholera morbus most resembles arsenic poisoning, and it 
is frequently mistaken for the latter. Two cases of this 
character fell under the author's notice a short time ago, 
where death occurred in about eight hours, both of which 
were mistaken for cholera morbus by the attending phy- 
sician, but both however yielded, by analysis, the most 
positive evidence of arsenic poison. 

Malignant cholera most resembles the action of tartar 
emetic in its symptoms, such as the excessive nausea and 
vomiting, the rice-water dejections, the cramps, the extreme 
weakness, etc. Gastro-enteritis, peritonitis, ulceration of the 
stomach, ilius, and hernia, all present symptoms which 
strongly resemble many of those witnessed from irritant 
poisons. 

Many of the features of apoplexy bear a striking resem- 
blance to the symptoms of opium poisoning; whilst epilepsy 
somewhat resembles poisoning from prussic acid, and the 
effects of strychnia bear a strong likeness to those of 
tetanus. 



POST-MORTEM EXAMINATION. 189 

A knowledge of the above facts should put the practi- 
tioner upon his guard against too hastily deciding on a case 
of poisoning froin the symptoms alone ; and, on the other 
hand, he should not be misled in attributing to a supposed 
disease what is really the result of a poison. 

11. Evidences obtained from Post-mortem Examination. — 
The rules governing an autopsy in a case of poisoning are 
the same as those which regulate other judicial post-mor- 
tem examinations. One important rule should always be 
observed, namely, that the examination should be thorough 
and exhaustive, " so as to overlook no lesion whatsoever, 
and no cause of either accidental or natural death." The 
rules already given for conducting a post-mortem investi- 
gation (Vid. ante, p. 56) need not be repeated here. It 
should not be forgotten that a careless, superficial autopsy 
of a body, where the symptoms had strongly resembled 
those of poisoning, might possibly lead to the conviction 
of an innocent person. 

The importance of receiving the stomach and other 
viscera into a perfectly clean jar may be inferred from the 
fact, that the showing that this vessel was not clean, at the 
trial, would be sufficient to destroy all the chemical testi- 
mony. This is well illustrated by a case communicated to 
the author by the late Prof R. Bridges, which occurred 
to himself. The poison suspected was arsenic, but the 
stomach, etc., were carelessly thrown into an old tin can 
that had formerly contained zinc-paint, before being sent to 
the analyst. He discovered zinc in the viscera, for which 
he was at a loss to account, until the above fact was 
ascertained. 

In the examination of the stomach, it is recommended to 
open this organ along the lesser curvature, and after care- 



190 TOXICOLOGY. 

fully collecting and measuring the contents, to spread it out 
upon a clean pane of glass, with the mucous surface out- 
ward ; it should then be carefully inspected, with the aid of 
a magnifier, and any abnormal appearance noted, together 
with any foreign substance, such as crystals of arsenic, frag- 
ments of phosphorus, suspicious powders, pieces of vege- 
table matter, etc. These should afterward be examined with 
the microscope. 

The evidences furnished by the post-mortem, like those 
derived from the symptoms, can never be absolutely con- 
clusive, but only strongly suggestive — and for a similar 
reason, viz., because many diseases exhibit precisely the 
same post-mortem lesions. Sometimes the external inspec- 
tion of the body may throw some light on the case, as when 
certain stains of the mineral acids are discovered about the 
mouth, cheeks, tongue and fauces, and also on the dress of 
the person. Occasionally, the odor of prussic acid, opium, 
alcohol, nicotine and phosphorus may be perceived on the 
corpse. On opening the body, the odor of the above sub- 
stances, if present, is usually more decided ; and in phos- 
phorus-poisoning the white fumes, which are luminous in 
the dark, as well as the alliaceous odor, are often very per- 
ceptible. Again, the remains of certain poisons may be, at 
times, discovered in the stomach and bowels, such as can- 
tharides, Scheele's green, nux vomica, arsenious acid and 
orpiment; also vegetable leaves and fibres, which latter may 
be recognized by their botanical features. The aid of the 
microscope may also be required. 

As regards the true pathological lesions resulting from 
poisoning, it may be remarked that, as a rule, the irritant 
poisons leave behind them decided marks of congestion and 
inflammation of the mucous membrane of the stomach and 
bowels, together, at times, with ulceration, perforation and 



EVIDENCE FROM CHEMICAL ANALYSIS. 191 

gangrene ; while the neurotics leave their impress upon the 
brain and spinal cord, in the form of congestion, inflamma- 
tion and effusion in these organs, and sometimes congestion 
of the lungs. The negative evidence, in the absence of all 
marks of irritation of the stomach and bowels, against 
irritant poisoning, although strong, is not positive, because, 
in exceptional cases, death from these powerful irritants 
may occur without leaving behind any pathological lesion. 
Among the most common of the post-mortem signs pro- 
duced by irritant poisons is redness ; this, however, is a con- 
stant symptom attendant on many disorders, and according to 
Dr. Yellowly, it often occurs simply as a post-mortem change. 
Ulceration is occasionally the result of irritant poisoning. 
The author has seen it twice in acute arsenical poisoning. 
It is however much more frequently the sequence of dis- 
ease; and as this latter is apt to be insidious, and generally 
unsuspected until a sudden fatal termination, it might 
readily be mistaken for a case of poisoning. Softening of 
the mucous lining of the stomach and bowels may result 
from both poisoning and disease ; it cannot, therefore, be 
accepted as a proof of the former. Perforation may occur 
from the action of a corrosive, as the mineral acids and 
alkalies, and also from disease ; but, in the latter case, the 
aperture is small, while in the former it is large and ragged 
and its edges are soft and friable; moreover, the poison 
escapes into the abdomen, and can there readily be detected. 

III. Evidences from Chemical Analysis. — The actual dis- 
covery of the poison by means of chemical analysis is usually 
regarded as the most satisfactory and positive evidence of 
poisoning; and it is a prevalent notion that the case cannot 
be made out without the production of the poison as the 
corpus delicti. This is, however, an error. The law requires 



192 TOXICOLOGY. 

the satisfactory proof of death by poisoning. The question 
is — can satisfactory proof be afforded without the chemical 
detection of the poison ? The reply to this inquiry is, that 
it undoubtedly can, in certain cases. Many convictions have 
occurred m trials for poisoning, without this particular line 
of proof. If it were always deemed absolutely essential, 
doubtless many criminals would escape. We believe this 
position to be a safe and logical one :- — if all the other factors 
of evidence are perfect — the symptoms, the post-mortem 
appearances, the effects on living animals, and the moral 
evidences, — then the chemical analysis is not necessary to 
substantiate the charge. It is well understood that for some 
poisons there is no known chemical test, especially for 
those derived from the vegetable and animal kingdom ; 
besides, circumstances may interfere to prevent a proper 
chemical examination. If, however, the other branches of 
evidence fail, and if at the same time, the chemical proofs 
are unsatisfactory, then the accused must be acquitted. 

On the other hand, supposing the analysis reveals the 
presence of poison in the stomach, this does not necessarily 
prove that the death resulted from poisoning. Indeed, in 
the absence of the usual symptoms, the pathological lesions, 
and the moral proofs, it might plausibly justify the suspicion 
that the poison had been secretly introduced into the body 
after death, for sinister purposes. 

The detection of the absorbed poison, in the organs, as 
the liver, spleen, kidney, etc., is justly regarded as a more 
satisfactory proof of poisoning than the mere discovery of 
it in the stomach. Indeed, it is by some considered as posi- 
tive and incontrovertible evidence. We do not fully assent 
to this, although admitting the statement as correct in the 
majority of cases. It should not be forgotten that, if a 
poison in a liquid state be introduced into the stomach or 



POST-MORTEM IMBIBITION OF POISONS. 193 

rectum of a dead body, by means of a tube, in a short time 
the Hquid Avill penetrate through the walls of the viscus, by 
osmosis, and will come in contact with the adjacent organs 
— the liver, lungs, pancreas, kidney, spleen, etc. — and will 
penetrate into these organs, so as to contaminate them more 
or less. Now, if, after several weeks or months' interment, 
a suspicion be aroused that the death had been caused by 
poison, and the body then be opened, very decided evidences 
will be afforded by the organs of what might very naturally 
be taken for absorbed poison. 

Cases of post-mortem imbibition of poisons are extremely 
rare; indeed, many authors deny their existence; but there 
is good reason to believe that they have occurred, and 
that they may be repeated. The author is familiar with 
the facts of one such case, the particulars of which were 
communicated to him; and in order to establish the possi- 
bility of its occurrence, together with the circumstances 
most favorable for its production, he had a series of experi- 
ments made, under his supervision, by Dr. Geo. McCracken, 
of the University of Pennsylvania, on the bodies of dogs 
and cats, with solutions of arsenious acid, corrosive sub- 
limate and tartar emetic, confining his experiments, for the 
time, to mineral poisons. These solutions were severally 
injected into the stomachs of the animals, and their bodies 
were buried for periods, respectively, of three, five, six and 
seven weeks, when they were disinterred, opened, and the 
different viscera subjected to chemical analysis, with the fol- 
lowing results: — after three weeks' burial, in the case of all 
the poisonous solutions, the characteristic colored spots of 
the respective sulphides were seen on the spleen, under sur- 
face of the liver, and that portion of the peritoneum posterior 
to the stomach, — yellow in the case of arsenic ; red in the 
case of antimony; and black \n the case of mercury. Each 



194 TOXICOLOGY. 

of the metals was likewise discovered by chemical analysis 
in the liver, spleen and left kidney; the greatest amount 
being found in the spleen ; next, in the portion of the liver 
joining the stomach; then in the left kidney; and next in the 
portion of liver farthest from the stomach ; and none in the 
right kidney. After six and seven weeks' interment the 
colored sulphide deposits were much more decided, being 
noticed on the upper, as well as the lower surface of the 
liver, together with the spleen, intestines, omentum and both 
kidneys; and, in the case of arsenic, even'extending as low 
down as the fundus of the bladder. By chemical analysis, 
also, the poisons were detected in all the above-mentioned 
organs. 

The inference from the above facts would naturally lead 
to the necessity of excluding the idea of the post-mortem 
introduction of the poison, in every toxicological investiga- 
tion connected with a trial for murder by poisoning. It is 
evident that, given a sufficient motive for the deed, it would 
not be a very difficult matter secretly to introduce a poison- 
ous liquid into the stomach of a dead person, and after the 
lapse of a few weeks or months to circulate the rumor of 
the death having been produced by poison. This would pro- 
bably lead to the disinterment of the body; and the chemical 
examination would reveal the existence of the poison, not 
only in the stomach, but also in the liver and other viscera. 
The conclusion, then, would naturally be that the individual 
had died from poison, because it had been discovered in the 
organs ; and this alleged discovery might lead to the con- 
viction of an innocent person. Under such circumstances, 
we deem it of the greatest importance to examine the brain, 
because a poison injected into the stomach could not pos- 
sibly find its way, by osmosis, through the bony cranium, 
into the brain. The finding of the poison, therefore, after 



RULES FOR ANALYSIS. 195 

death, in the brain or spinal marrow, maybe regarded as one 
of the strongest evidences of its ante-mortem administration. 
But we do not maintain that the poison must be found in 
the brain, in order to substantiate the charge. 

Chemical analysis sometimes fails to discover the poison 
after death, and for this failure several good reasons can be 
assigned : (i) It may all have disappeared before death, by 
vomiting and purging, and by elimination through the 
secretions. Arsenious acid, however, is very apt to adhere 
to the mucous lining of the stomach, in spite of long and 
violent vomiting. (2) It maybe undiscoverable by chemical 
analysis, from its very nature ; there is no known reagent 
that will detect the poison of glanders or rabies, and also 
many of the vegetable poisons. The mineral poisons may 
usually be easily identified. (3) Loss by absorption and 
elimination. This is apt to be the case where the dose of 
the poison was only just sufficient to cause death, and death 
was not very rapid. (4) The decomposition of the poison 
in the blood, or during its elimination. This is much more 
apt to occur with organic, than with inorganic substances. 
(5) Its possible decomposition in the dead body. This does 
not occur with the mineral poisons ; although the chemical 
composition of these may undergo change after death, as, 
e.g., arsenious acid into the yellow sulphide, yet the fitetal 
remains indestructible. 

In performing a toxicological analysis, certain rules 
should be observed, which will greatly facilitate the process. 
First of all, the examiner should, if possible, inform himself 
of the character of the symptoms^ and (if the case was fatal) 
of the post-mortem, as these will usually indicate to what 
particular class of poisons he should direct his researches. 
Secondly, his analysis should be conducted with scrupulous 
care and accuracy. In searching for the more complex 



196 TOXICOLOGY. 

organic poisons, it is a good plan to reduce the liquid, by 
evaporation, to a very small bulk, since a minute quantity 
of a poison diffused through a large amount of water 
may fail to respond to the proper tests. It is best, also, 
to operate on one-half of the material, reserving the 
other portion in case of accident, or for further experi- 
ments. The suspected substance ought to respond to 
all the recognized tests, the characteristic ones being first 
appHed; and, in metallic poisoning, we deem it essential 
for the analyst to produce the metal, along with the other 
results. This can always be accomplished without much 
difficulty, e.g. in the case of arsenic, mercury, antimony, 
copper, lead, etc. This remark, of course, does not apply 
to the metals of the alkalies or earths. Too much reliance 
should not be placed on the mere color of precipitates, as 
this is often fallacious, from being disguised by admixture 
with foreign matters, or uncertain, from its resemblance to 
other substances. As instances, we may cite the impure 
sulphides of arsenic and antimony, the two liquid tests for 
arsenic, and the resemblance between the action of the 
persalt of iron upon opium, and upon the saliva. Finally, 
the analyst should be careful to test the purity of all his 
reagents, remembering that many of the so-called chemi- 
cally pm-e reagents often contain impurities which may 
seriously damage his examination. 

IV. Evidences from Experijnents on Living Animals. — In 
cases where the poison cannot be identified by the symp- 
toms, post-mortem lesions and chemical tests, the suspected 
material may be introduced into a living animal (a dog, cat, 
rabbit, guinea pig, or mouse), and its effects noted. In the 
case of strychnia, the frog would be appropriate as a cor- 
roborative test. Birds are not so well adapted for experi- 



CIRCUMSTANTIAL EVIDENCE OF POISONING. 197 

ment. The character of the information thus derived is 
confined to the mere fact of poisoning, together with some 
of its physiological and pathological actions. By this means 
the presence of digitalis was identified in a celebrated French 
case, and aconite in the case of Dr. Lamson, in England. 

The material to be employed in such cases is usually the 
matters vomited, or that found in the stomach and bowels 
of the deceased ; but the examiner should avoid a too hasty 
conclusion, inasmuch as disease might cause the secretions 
of the alimentary canal to become infected, and thus to act 
upon the animal poisonously, although no poison had really 
been taken by the deceased ; and, on the other hand, 
although poison may originally have been present in the 
stomach, it might have all been expelled by vomiting, or 
undergone decomposition, so that the contents of the 
stomach would no longer produce a poisonous impression 
on the animal. 

Another fact to be noticed in this connection is, that a 
poison 77tay be introduced into the human system through the 
body of an animal^ without the latter bei?ig affected by it. A 
case is recorded where a family exhibited all the evidences of 
belladonna-poisoning after partaking of a rabbit pie ; the 
defence, which was successfully set up, was, that the animal 
had previously eaten of the belladonna plant, by which its 
flesh had become poisonous. It is well known that the cow 
and goat will feed upon the stramonium with impunity, and 
that their milk will act poisonously upon those who partake 
of it. 

V. Evidences derived from Circumstances. — Although the 
medical expert is not generally concerned with this sort of 
testimony, yet, in poison cases, the medical and moral evi- 
dence are often so closely connected that the expert may 



198 TOXICOLOGY. 

throw considerable light upon it. These *' circumstances " 
are the following : (i) The suspicious conduct of the accused 
before the eveitt, such as dabbling in certain poisons not in 
the line of his calling. This was a very strong point against 
the Count Bocarme who poisoned his brother-in-law with 
nicotine. (2) The pwchase aiid possession of poison by the 
accused. Of course, this may be satisfactorily accounted 
for. (3) The proof of administration in the food or didnk of 
the deceased. (4) A sufficiently strong motive for the act. 
(5) Suspicious conduct of the accused during the illness^ and 
after the death of the deceased — such as preventing his ob- 
taining medical advice; assuming the exclusive care of the 
person, as to the giving of his food or administering the 
medicines ; carefully removing and disposing of all vomited 
matters, together with the excreta; and expressing the 
opinion of the probability of a speedy and fatal termination 
of the case ; and, after the death, opposing an autopsy, has- 
tening the burial, and giving a false account of the illness. 

The above series of " evidences " of poisoning constitutes 
a chain of proof which is perfectly conclusive in any indi- 
vidual case ; but we are not always able to exhibit every 
link of this chain ; nor is this always necessary in order to 
substantiate the allegation of poisoning, since " satisfactory 
proof" of poison having been the cause of death maybe 
made out in the absence of one, or even two, of the above 
'* evidences." 

Certain medico-legal questions will naturally present them- 
selves in every case of poisoning that comes up for trial : 
(i) Is the death or sickness to be ascribed to poison? This 
question is fundamental, as it compels the expert to exhibit 
his proofs of the poisoning. (2) What is the nature of the 
alleged poison? It is rarely in the power of the toxicologist 



MEDICO-LEGAL QUESTIONS. ^ 199 

to exhibit the identical poison that caused the death, as the 
corpus delicti. In most cases, all that is possible to do is to 
demonstrate all the known chemical and (occasionally) 
physiological tests. In the case of the mineral poisons, it is 
deemed sufficient to exhibit the metal, and the results of the 
recognized chemical reactions. In some cases of mineral 
poisons, however, it is possible to extract the identical sub- 
stance that was administered, if it were crystalline — such as 
arsenious acid, corrosive sublimate — and tartar emetic, by 
the process of dialysis. (3) Was the substance administered 
capable of causing death? This question is likely to arise 
only in non-fatal cases. If it can be shown that the sub- 
stance, although criminally administered, was not poisonous 
(although supposed to be), conviction would not follow; 
neither, if the substance were poisonous only in large doses, 
as oxalic acid, and a very small quantity — only a few grains, 
had been given. (4) Was the poison taken in sufficient quan- 
tity to produce death? The discovery of a large amount of 
poison in the body is a pretty sure evidence of the cause of 
death ; but the finding of only a minute quantity, or its total 
absence from the body, is not positive proof that death was 
not caused by poison (Vid. ante,^. 192). (5) Wheit was 
the poison taken? This question can generally be answered 
by referring to the time of the first appearance of the symp- 
toms, together with their duration; but it is affected by 
various conditions {^Vid. ante, p. 187). (6) Alay the poison 
have entirely disappeared from the body, zvithout leaving any 
trace? The answer must be affirmative, if the person has 
survived long enough to allow of its complete elimination 
{ante, p. 181). (7) Might the poison found in the body be 
ascribed to any other source than to poisoniitg ? Not, if it is 
found in considerable quantities, and in the absorbed state, 
in the organs. But, if in minute quantity, it might have been 



200 _ TOXICOLOGY. 

introduced medicinally, or accidentally. (8) Can poisoning 
be pretended? Undoubtedly, just as various diseases are 
feigned for some special motive; but the imposture can be 
discovered by close watching. The idea of being poisoned 
is a very common delusion of the insane. 

The above medico-legal questions have been chiefly taken 
from the treatise of Tardieu (^Sur V Empoisonnemeni). 

Classification of Poisons. — Of the numerous classifi- 
cations of poisons which have been proposed at various 
times, two only require notice here. One of these is founded 
on the natural source or kingdom from which the poison is 
derived, and is expressed by the two classes of btorganic 
and Organic poisons ; or by those of Mineral, Vegetable and 
Anijnal poisons. The other classification, which may be 
termed the physiological, has reference to the effects of 
poisons upon the healthy animal system. The classification 
adopted in the present treatise is founded upon the latter 
arrangement, as being the most philosophical. It is based 
upon the one proposed by Dr. Taylor, with some few modi- 
fications. 

All poisons are divided into two Classes, I. Irritants ; 
II. Neurotics. 

I. Irritants. — These include such poisons as produce an 
irritant action upon the mucous coat of the alimentary canal, 
the effects being an acrid, burning taste on swallowing, 
nausea, vomiting, purging, pain in the abdomen, cramps in 
the stomach ; the matters vomited and purged being at 
times mixed with blood. The post-mortem lesions are more 
or less inflammation of the gastro-intestinal mucous mem- 
brane ; sometimes ulceration, perforation and gangrene. 

The Irritants may be subdivided into two orders: 
(i) Simple irritants; and (2) Irritants possessing remote 



CLASSIFICATION OF POISONS. 201 

specific properties. They may further be separated into 
three sections, depending on the source from which they are 
procured, viz. (a) Mineral, (d) vegetable, (c) animal ; and the 
mineral are finally subdivided into non-metallic and metallic. 
Some of the irritants are properly named corrosives, on 
account of their destructive chemical action on the tissues. 
If diluted, the corrosives act as simple irritants. 

11. Neurotics. — These are so named on account of their 
specific action on the great nervous centres, the brain and 
spinal marrow. The symptoms are altogether distinct from 
those of the former class, being directed especially to the 
brain and spinal cord. These are drowsiness, giddiness, 
headache, delirium, stupor, coma, and sometimes convul- 
sions and paralysis. They are naturally subdivided into 
three Orders: (i) Cerebral, (2) Spinal, (3) Cerebro-spinal. 
The first of these Orders comprise (a) Narcotics, (b) Anaes- 
thetics. The second Order includes those which act directly 
upon the spinal cord, such as strychnia ; they are sometimes 
termed Tetanies. The third Order comprises those which in- 
fluence both the brain and spinal marrow, producing delirium, 
coma, convulsions and paralysis. These latter may be 
grouped under the three heads of Deliriants, Depressants and 
Asthenics. The above arrangement is to a great extent an 
arbitrary one, and must, of course, be somewhat imperfect, as 
the boundary line between the different classes and orders of 
poisons cannot always be accurately drawn. The following 
tabular arrangement exhibits the classification at a glance : — 

TABLE OF CLASSIFICATION, 
p, J ] Order I. Irritants proper. [Mineral. ] Non-metallic. 
iRRrrlNTS r " ^- " producing \ Veg'able. | Metallic. 
iKKiiAiNib.j remote specific effects. [Animal. 

Class II. 1 Order r. Cerebral. { 2-°;- ^, 

I " 2. Spinal or Tetanies. 
I r Deliriants^ 

Neurotics, j " 3. Cerebro-Spinal. \ Depressants. 
10 I Asthenics. 



202 TOXICOLOGY. 



CHAPTER XIV. 

CLASS I.— IRRITANT POISONS. 
POISONING BY THE MINERAL ACIDS. 

CERTAIN COMMON SYMPTOMS. — POST-MORTEM APPEARANCES. — TREAT- 
MENT. — CHEMICAL ANALYSIS. — TOXICOLOGICAL EXAMINATION FOR 
THE DIFFERENT ACIDS. 

The mineral acids — Sulphuric, Nitric and Muriatic — pos- 
sess certain general characters, and produce certain common 
effects upon the system, which may properly be considered 
together. This action is entirely local. They are seldom 
used for homicidal purposes except in the case of young 
children ; they are occasionally employed by suicides, but 
more frequently are the cause of accidental death. 

Their symptoms are exhibited immediately on being swal- 
lowed, and consist of a burning in the mouth and gullet, 
with intense pain in the stomach, attended with constant 
eructations and vomiting of a brownish or blackish matter, 
often mixed with blood, together with mucus and shreds of 
detached mucous membrane. The ejected matters are in- 
tensely acid, and if they happen to fall upon a marble slab 
they produce effervescence; they also change the color and 
destroy the texture of the cloth, or other material, on which 
they may fall. Swallowing is very painful, and sometimes 
impossible. Thirst is intense; the bowels are constipated 
and the urine diminished. The pulse is small and weak 
and the skin cold and clammy. Respiration becomes diffi- 
cult, and the countenance expressive of great anxiety. There 
may also be cough and difficulty of speaking. Death may 



MINERAL ACIDS TREATMENT. 203 

occur from suffocation, when the force of the acid Is spent 
upon the glottis and upper portion of the windpipe. The 
mouth is excoriated, and the hps are stained and shriveled. 
When the acid has been poured far back down the throat, 
in the case of infants, the mouth and lips may entirely es- 
cape injury, the corrosive action being confined to the glottis 
and adjacent parts. The mental faculties usually remain 
clear, the patient dying convulsed or suffocated. 

The result is generally fatal, although the period of death 
may vary from a few hours, to weeks or months. 

Post-mortem appearances. — Stains of a brownish or yel- 
lowish hue are apt to be found on the lips and cheeks; also, 
on portions of the dress of the deceased. The lining of the 
mouth and tongue is shriveled and eroded, stained yellowish 
in the case of nitric acid, and sometimes of a whitish color. 
At times the mucous membrane of the windpipe appears to 
have suffered most from the corrosive action of the poison, 
and cases are reported of sulphuric acid poisoning, where 
all other parts of the body had entirely escaped. The lining 
membrane of the oesophagus is usually softened, detached 
in long shreds, and deeply congested; the stomach con- 
tracted, often perforated, sometimes blackened, containing 
a dark grumous liquid; at other times it presents a yellowish 
appearance. The intestines are likely to be inflamed, unless 
the death has been very rapid. If the contents of the 
stomach have escaped into the cavity of the abdomen, 
through perforation, the peritoneum will be found intensely 
inflamed, with more or less of dark, effused blood. 

Treatment. — No remedies are likely to prove efficient 
when the undiluted acid has been swallowed. The proper 
treatment consists in administering a solution of the bi- 
carbonate of potassium or sodium; or, in the absence of 
these, of chalk or magnesia, stirred up in water, together 



204 TOXICOLOGY. 

with copious diluents, such as barley water, flaxseed tea, oil, 
etc. The stomach pump should not be employed, on ac- 
count of the risk of perforating the softened oesophagus. 

Sulphuric Acid. — This acid is commercially named Oil 
of Vitriol. In its concentrated state, it is a heavy, oily liquid, 
of a light-brownish color; sp. gr. 1.845; intensely sour, and 
has a very acid reaction. 

The diluted diCid is colorless, very acid, non-corrosive; it 
chars paper which has been dipped into it and dried by the 
aid of heat. 

Sulphuric acid is more frequently the cause of death than 
the other mineral acids. Several cases of homicide are re- 
ported where it was introduced into the rectum and vagina. 
Tht fatal dose for an adult is a fluid drachm; for an infant, 
half this quantity. The danger depends more on the degree 
of concentration than upon the absolute quantity swallowed. 
Death usually occurs within twenty-four hours, and in cases 
where its action is spent upon the rima glottidis, producing 
suffocation, the fatal result may be almost immediate. Ac- 
cording to Casper, the bodies of those poisoned by sulphuric 
acid resist putrefaction for a long period. 

There is good reason for believing that this acid is ab- 
sorbed into the circulation and eliminated by the secretions. 
It has been detected in the urine during life. 

Chemical a^talysis. — The concentrated acid is recognized 
by its oily appearance; it chars organic bodies; it evolves 
considerable heat when mixed with an equal bulk of water; 
it gives off sulphurous acid fumes when boiled with copper, 
mercury, wood chips or charcoal. The diluted acid is easily 
detected by its producing a white precipitate, with the nitrate 
or chloride of barium, insoluble in nitric acid. To confirm 
this result, the precipitated sulphate of barium should be 



TOXICOLOGICAL EXAMINATION. 205 

dried and mixed with some reducing agent (charcoal, cyan- 
ide, or ferrocyanide of potassium), and heated to redness ; 
the sulphate of barium is by this means converted into the 
snip] tide ; and when this is moistened with diluted hydro- 
chloric acid, the smell of sulphuretted hydrogen is at once 
perceived, proving the presence of sulphur in the original 
acid. 

It may be objected to this test that several other acids 
besides sulphuric throw down white precipitates with nitrate 
of barium, as, e. g., carbonic, phosphoric, oxalic, boric acids, 
etc. The answer to this is, that either nitric or hydrochloric 
acids will immediately dissolve all the last-named precipi- 
tates, while the sulphate remains untouched by them. 

Another objection is that any neutral sulphate will pro- 
duce the same precipitate with nitrate of barium as the free 
acid. This is true ; but the two may easily be distinguished 
by evaporating a drop of the suspected solution to dryness 
on a piece of glass ; if it consisted of free acid, no residue 
would remain ; but if it contained a sulphate, a saline 
residue would be left. But the case may present where the 
solution contains both the free acid and some soluble sul- 
phate; here, finely-powdered carbonate of barium should be 
added, first warming the liquid ; this will precipitate ih^free 
sulphuric acid only ; hence, the resulting sulphate of barium 
will represent all the free acid present. 

Another delicate test is veratria. A small portion of this 
alkaloid is introduced into the diluted acid and carefully 
evaporated to dryness ; a beautiful crimson-purple color is 
developed. Moreover, as this test produces no effect upon 
a sulphate, it serves to distinguish the latter from the free 
acid. 

Toxicological examination. — The organic matters, if thick 
and viscid, should be boiled with the addition of distilled 



206 TOXICOLOGY. 

water, and the solution filtered, and a measured portion, 
acidified by nitric acid, next precipitated by nitrate of barium, 
and the precipitate washed and dried. In medico-legal cases, 
this precipitate may be reduced by heat and ferro-cyanide 
of potassium, and further tested, as mentioned above. 

It might happen that the solution contained a soluble sul- 
phate, along with some other acid — citric, acetic, etc. The 
mode of distinguishing this from a solution containing free 
sulphuric acid is as follows : a given volume of the solution 
is acidulated with nitric acid and precipitated with nitrate of 
barium, and the precipitate washed, dried and weighed. An 
equal volume of the original solution is evaporated to dry- 
ness, in order to dissipate any free sulphuric acid, and is then 
dissolved in pure water, filtered, and precipitated as before, 
and the dried deposit weighed. If the weight of each of these 
precipitates is equal, there was no free sulphuric acid present; 
but if the weight of the former precipitate exceeds that of the 
latter one, then the excess of weight will indicate exactly 
the amount of \k\Qfree acid present in the original solution. 

Detection of stains on clothing. — The color of the stains 
made by sulphuric acid on dark cloth is red or brownish-red, 
and they retain their moisture for a long time; on other 
colored substances they produce a bright red, and sometimes 
a yellowish stain. To recognize the acid, a few of these 
spots should be cut out of the garment and boiled with a 
little distilled water, and tested with the nitrate of barium. 
A portion of the cloth should also be tested at the same 
time, in order to show the absence of any sulphate. 

Quantitative analysis. — Sulphuric acid is estimated as a 
sulphate ; the precipitated sulphate, after careful washing in 
hot water, with a little hydrochloric acid, is collected on a 
filter, dried and weighed ; lOO parts of the sulphate are 
equal to 42.02 parts of monohydrated sulphuric acid. 



NITRIC ACID POST-MORTEM LESIONS. 207 

Nitric Acid [Aqua Fortis)^ as found in commerce, is a 
powerful corrosive acid, of a yellow or orange color, the 
color being due to a mixture with peroxide of nitrogen. 
Sp. gr. 1.35 to 1.45. It is apt to be contaminated also with 
sulphuric acid, chlorine and iron. It is seldom used as a 
poison. Orfila relates a case where a man poured this acid 
into the ear of his drunken wife, which caused her death by 
inflammation of the brain and destruction of the bones, 
seven weeks afterwards. This, however, can scarcely be 
regarded as an instance of poisoning. 

Symptoms. — Similar to those caused by sulphuric acid, 
except that the lips, tongue and inside of the mouth are 
stained yellow. Spots upon the cheeks, neck and other 
parts of the body, and of the dress, are also yellow. The 
teeth are white ^ but yellowish at their junction with the 
gums. The purging is sometimes accompanied with blood. 
The vapors of this acid may cause death by bronchial con- 
gestion ; care should therefore be taken to avoid their 
inhalation in the manufacturing of gun-cotton, etc. 

Fatal dose. — Two drachms of the concentrated acid have 
proved fatal to an adult; though larger doses have been 
taken with impunity. Life is usually destroyed within 
twenty-four hours, but frequently it is protracted, and in a 
case related by Tartra, death did not occur for seven months. 
Treatment. — This is essentially the same as that recom- 
mended for sulphuric acid. 

Post-mortem appearances. — The lips, tongue and inside of 
the mouth present a yellow, or yellowish-brown appearance ; 
the mucous membrane of the oesophagus is colored yellow, 
softened, and peels off in pieces ; the larynx and glottis may 
have suffered, as in the case of sulphuric acid. The stomach 
may be distended, presenting a greenish color, due to the 
action of the acid on the bile; it may be found in a pulpy 



208 TOXICOLOGY. 

state, perforated, and adherent to the adjacent viscera, and 
even partially destroyed. The contents have usually a yel- 
low color; the lining membrane is deeply congested, and 
the vessels filled with dark blood; sometimes the open 
mouths of the vessels can be seen. The upper portions of 
the intestines may exhibit the same appearances as the 
stomach. The large intestine is apt to escape. In chronic 
poisoning there is great emaciation, and, after death, con- 
traction of the pylorus, with softening of the mucous mem- 
brane, has been found. 

Oieviical analysis. — The concentrated acid is recognized 
by — (i) giving off colorless, or orange-colored fumes when 
exposed to the air; (2) by leaving no residue when heated 
in a watch glass; (3) by giving off dense orange-red fumes, 
in the cold, when poured on fragments of copper, or on mer- 
cuiy, zinc and tin (dilute acid requires to be boiled on these 
metals to produce the same result) ; (4) by its negative 
action on gold leaf; but if about twice its volume of strong 
hydrochloric acid be added, a solution of the gold imme- 
diately takes place. 

The dilute acid is tested as follows : (i) The addition of 
nitrate of barium and nitrate of silver causes no precipitates, 
showing the absence of sulphuric and hydrochloric acids. 
(2) Boil with fragments of copper ; the red fumes will indi- 
cate the nitric acid action. (3) Neutralize with carbonate 
of potassium, and moisten a piece of filtering paper in the 
resulting solution (nitrate of potassium) ; when the paper is 
dried, it will scintillate on burning, like touch-paper. 
(4) Evaporate the above solution until crystallization ; ex- 
amine the crystals with a magnifier (six-sided striated prisms 
of nitre). If the solution be neutralized with carbonate of 
sodium, the crystals will present the rhombic form of nitrate 
of sodium. (5) Put a fragment of these crystals into a small 



TOXICOLOGICAL EXAMINATION. 209 

test-tube, along with a little copper filings and a few drops 
of sulphuric acid and water ; slightly heat, when there will 
be an escape of orange-red fumes, and the production of a 
blue liquid (nitrate of copper). (6) Proceed as in (5), but 
instead of copper filings, add a fragment of morphia, when 
an orange-colored solution will result, the color becoming 
fainter on boiling. (7) As in (5), substituting for the copper 
a crystal of brucia, which will yield a blood-red color, dis- 
appearing on the addition of chloride of tin. (8) The iron 
test. Proceed as in (5), except to add an excess of sulphuric 
acid and allow it to cool ; then pour in gently a freshly-pre- 
pared solution of sulphate of iron ; a fine purple color is 
immediately formed at the line of junction, which speedily 
extends throughout the liquid, if cool; if heated, the color 
disappears with the evolution of the orange-red fumes. 
(9) A weak solution of sitlpJiate of indigo ; when heated in 
contact with a crystal of nitrate of potassium and sulphuric 
acid, the color disappears. (10) As in (5), using a crystal 
of narcotina instead of copper ; a reddish-brown color is pro- 
duced, changing by gentle heat to a blood-red. (11) The 
gold test, as in (5), substituting for the copper a piece of 
gold leaf and some pure hydrochloric acid ; the gold will 
dissolve, and the solution may be tested by protochloride of 
tin, which imparts to it a purple color. (12) As in (5), 
substituting for the copper a fragment of pyrogallic acid 
and a few grains of chloride of sodium ; an intense purple 
hue is imparted to the solution. 

Toxicological exantination. — First, test the organic mat- 
ters (as contents of stomach, etc.), with litmus paper ; the 
acid may have been neutralized by the alkaline antidotes. 
If viscid, add a sufficient quantity of distilled water, and boil 
gently for about a quarter of an hour ; filter ; if found to be 
acid, neutralize with carbonate of potassium and crystallize 
10* 



210 TOXICOLOGY. 

by evaporation ; drench the crystals with strong alcohol, to 
remove impurities, and test them by the methods above 
described. If the matters examined are not acid, they 
should be boiled with strong liquor potassse, to break them 
up ; then add sulphuric acid ; filter, crystallize and test as 
above. 

The urhie should always be examined for nitric acid, by 
distillation with sulphuric acid, and neutralizing the distillate 
with carbonate of potassium. 

The tissues may be examined as follows : Make a mixture 
of equal parts of sulphuric acid and water, and put twenty 
or thirty drops into four test-tubes. 

To (i) add a little brucia ; no change should result. Add 
now a little piece of the tissue to be examined, when the 
solution, if nitric acid be present, will turn a blood-red 
color. 

To (2) add a trace of stdpJiate of indigo ; no action should 
result. Add now a piece of the tissue, when, if nitric acid 
is present, the color will disappear. 

To (3) add a few grains of copper filings and a piece of 
the tissue, and boil. The evolved reddish vapors, if nitric 
acid be present, will give a blue color to a piece of white 
paper moistened with a solution of iodide of potassium and 
starch. 

To (4) add a solution of stdphate of iron ; on adding a 
piece of the tissue, the solution will become of an olive- 
brown color, if nitric acid is present. (Woodman and Tidy, 
For. Med. p. 251.) 

Suspected stains are examined by soaking the fabric or 
other substance in warm distilled water. If acid, the solu- 
tion should be neutralized with carbonate of potassium, and 
the resulting crystals treated as above directed. The color 
of these stains, as before mentioned, is yellow ; they can be 



HYDROCHLORIC ACID. 211 

distinguished from stains of iodine and bile by the appHca- 
tion of a weak solution of potassa, which intensifies the 
nitric stain, whilst it discharges the iodine (or bromine) 
stain, and does not affect the bile. 

Free nitric acid in solution may be estimated by satu- 
rating it with recently ignited carbonate of sodium ; every 
53 grains of which will neutrahze 54 grains of anhydrous 
acid N2O5. 

Hydrochloric Acid. — This acid, known commercially 
as Muriatic Acid, and Spirit of Salt, as usually found, has 
a light yellow color, fumes when exposed to the air, is 
powerfully acid, and has a sp. gr. of about 1.15. When pure 
it is colorless; its yellow hue is due to chlorine or chloride 
of iron. The commercial acid frequently contains nitric 
acid, arsenic and antimony, as impurities. Instances of 
poisoning by it are comparatively rare, except as the result 
of accident. 

Syinptotns. — These are, generally, similar to those occa- 
sioned by the other mineral acids. A grayish or white ap- 
pearance of the tongue and interior of the mouth, with the 
formation of a false membrane, is usually observed. 

Fatal dose. — Half an ounce for an adult; a drachm has 
destroyed a child. Tho. fatal period varies from a few hours 
to many weeks. 

The treatment is the same as that above described for the 
other mineral acids. 

Post-mortem appearances. — These, on the whole, resemble 
the lesions found in cases of death from the other two acids, 
although they more closely assimilate the appearances pro- 
duced by sulphuric acid, in the blackened or charred ridges 
often noticed in the interior of the stomach. The oesophagus 
presents a denuded appearance, from the detachment of its 



212 TOXICOLOGY. 

mucous membrane. The glottis and larynx may also be 
deeply injected and corroded, in cases where the poison has 
spent its effects on these organs. 

Chemical analysis. — The strong acid is distinguished from 
other acids — (i) by its yellow color; (2) by its giving off 
dense white fumes in contact with ammonia — best shown by 
holding a glass rod wetted with the acids over an open bot- 
tle of aqua ammoniae; (3) by its negative action on copper 
or mercury, even when heated; (4) by its evolving chlorine 
when heated with peroxide of manganese. 

The dilute acid is tested by a solution of nitrate of silver ^ 
which is characteristic. A very dilute acid gives with this 
solution a copious white, curdy precipitate of chloride of 
silver, which soon darkens on exposure to light, and is in- 
soluble in boiling nitric acid, but very soluble in ammonia. 
When dried and heated, it fuses into a yellow liquid, which 
on cooling becomes a soft, horny mass. As any soluble 
chloride, e. g. common salt, will yield the same precipitate 
with nitrate of silver, a drop of the original solution should 
be evaporated on a glass slide; if it was free acid it will all 
disappear; if a chloride, a residue will be left. 

Nitrate of silver also precipitates several other acids and 
substances, but they all, with the exception of that from 
hydrocyanic acid, dissolve in nitric acid. The cyanide of 
silver is also soluble in boiling n\\x\z acid; and is further dis- 
tinguished by its crystalline appearance, and by its giving 
off cyanogen gas, when heated in a glass tube. 

Toxicological examination. — As this acid is volatile, the 
distilling process may be applied. The organic matters 
(such as the contents of the stomach, together with the 
viscera, properly cut up) should be put into a glass retort 
with a small quantity of pure water, and distilled nearly to 
dryness. The first portion of the distillate maybe rejected; 



HYDROCHLORIC ACID STAINS. 213 

but the remainder will usually yield the characteristic test 
with nitrate of silver. 

The above method, however, is liable to two fallacies : 
First, there is always apt to be present in the gastric juice 
of the human stomach a variable quantity of ;2(?r;;/^/ hydro- 
chloric acid; and secondly, ck/oride of sodium is frequently 
found there, being introduced with the food. Consequently, 
it would not be safe, in a medico-legal case, to rest the proof 
of poisoning by hydrochloric acid on the chemical analysis 
exclusively. If the symptoms and the post-mortem lesions 
did no^ indicate death from a corrosive acid, the mere 
detection of this acid after death by the chemical examina- 
tion would be of no value. 

In order to determine whether hydrochloric acid is 
present in the free state, or merely as a cJdoride, in any 
organic mixture, or whether in both conditions, the solid 
matters should be divided into small fragments and sufficient 
distilled water added, and the whole gently boiled for half 
an hour, then cooled and filtered. Equal measures of the 
liquid are then taken ; one is precipitated with nitrate of 
silver, after adding a little nitric acid, and the precipitate is 
washed, dried and weighed. Evaporate the second portion 
of the original liquid to dryness in a water bath, so as to 
dispel all the free acid ; dissolve the residue in pure water 
and precipitate with nitrate of silver, as before ; filter, dry 
and weigh this precipitate. The weight of the first pre- 
cipitate of chloride of silver will give all the hydrochloric 
acid present — both free and in combination ; the weight of 
the second precipitate indicates only the combined acid ; the 
difference in the two weights will indicate the amount of 
free acid present in the original solution. 

The stains of hydrochloric acid on dark cloth are at first 
of a briglit-rcd color, changing, after some days, to a red- 



214 TOXICOLOGY. 

dish brown. They may be examined after the method 
already described. The experiment should, however, be 
verified by testing another portion of the garment not 
having a stain. 

This acid is sometimes used to erase ink marks in cases 
of forgery. The paper thus acted on should be treated in 
the same manner as mentioned for the cloth. 

Hydrochloric acid is estimated as chloride of silver ; 
every lOO grains of the latter are equivalent to 77.80 parts 
of acid of sp. gr. 1.15. 



THE ALKALIES. 215 



CHAPTER XV. 

POISONING BY THE ALKALIES AND THEIR SALTS. 

SECTION I.— POTASSA.— SODA.— AMMONIA. 

SIMILARITY OF EFFECTS. — SYMPTOMS. — FATAL DOSE. — TREATMENT. — 
POST-MORTEM APPEARANCES. — CHEMICAL ANALYSIS. 

The three alkaHes, Potassa, Soda and Ammonia, on 
account of their similar quaHties, may properly be considered 
together in their toxicological relations. Their effects upon 
the animal system are very analogous, and these again 
strongly resemble the impressions produced by the mineral 
acids — being powerfully caustic in their concentrated state. 
They attack the tissues with which they come in contact by 
virtue of their chemical affinities, causing their disorganiza- 
tion and complete destruction. They are very rarely used 
for homicidal poisoning, but they occasionally prove fatal 
as the result of accident. 

Ptire caustic potash and soda are found almost exclusively 
in laboratories. Commercial potash and soda occur under 
the names of pot and peaid ashes, and soda ashes, or soap 
lees. These are all impure carbonates, containing a variable 
proportion of the respective alkalies. They are much em- 
ployed in the arts in the manufacture of glass and soap. 
They are highly caustic in their effects on the system. 

Ammonia, or volatile alkali, in its pure state, is a gas ; the 
Aqua Ammonice of the shops is a concentrated solution of 
this gas in water, and is a highly caustic substance. The 
two former alkalies, together with their salts, are yz;r^</ when 
heated ; the latter is volatilized by heat, by which circum- 
stance they are readily distinguished from each other. 



216 TOXICOLOGY. 

Symptoms. — In the concentrated state they occasion an 
acrid, nauseous taste, followed by a burning sensation in the 
throat and stomach; violent abdominal pain, increased by 
pressure; vomiting of mucous matters, tinged with blood; 
purging of a similar character, with tenesmus; difficulty of 
swallowing, hoarseness and coughing. The pulse is quick 
and feeble, the countenance anxious; the body is covered 
with a cold, clammy sweat; the respiration is rapid, with 
great muscular prostration. Death may ensue in a few 
hours, or it may be postponed for months^ or even years. 
In the latter cases, the fatal result is owing to secondary 
causes, such as stricture of the oesophagus and of the py- 
lorus, occasioning starvation. 

The effects of swallowing a strong solution of ammonia 
are similar to those above described, except that they are 
often more rapid, and are apt to be directed to the organs of 
respiration by the vapor given off. 

The incautious application of the vapor of ammonia to 
the nose, in cases of syncope, is sometimes followed by fatal 
results, for this same reason. 

Fatal dose. — As in the case of the mineral acids, the fatal 
effects of the alkalies depend rather upon their degree of 
concentration than upon the actual amount swallowed. 
Half an ounce of caustic potash is the usual fatal dose ; but 
an ounce and a half of the solution of the shops, containing 
about forty grains, has caused death. Strong aqua ammonicE 
has proved fatal in the dose of two drachms ; but instances 
of recovery are more frequent from this than from the fixed 
alkalies. Recovery has occurred after swallowing over an 
ounce of liquid ammonia. 

Treatment. — The stomach pump should never be used. 
Dilute vinegar or lemon juice should be freely swallowed', 
together with oil, or other demulcents. Opium may be given 



TESTS FOR POTASSA. 217 

to quiet pain, and stimulants to counteract the depression. 
The inhalation of acetic acid might prove beneficial in poi- 
soning by vapor of ammonia. 

Post-mortem appearances. — The lining membrane of the 
mouth, throat, oesophagus and stomach exhibit evidences of 
corrosion in their softened and abraded condition; at times 
the mucous coat of the stomach is blackened from the effused 
blood, and may be completely destroyed. The larynx and 
bronchi may be inflamed and softened, especially in the case 
of ammonia poisoning. In chronic cases, the mucous mem- 
brane of the oesophagus may be much thickened, and its 
calibre, as also that of the pylorus of the stomach, extremely 
contracted. 

Chemical properties. — All the alkalies neutralize acids, turn 
turmeric paper brown, and restore the blue to reddened litmus. 
They are not precipitated by sulphuretted hydrogen, am- 
monium sulphide, or ammonium carbonate. Corrosive^sub- 
limate causes a yellowish precipitate with the fixed alkalies, 
and a white one with ammonia.. 

Potassa is distinguished from soda as follows: — 

(i) Bichloride of platinum causes with the former, if not 
too dilute, a yellow double chloride of potassium and pla- 
tinum, which under the microscope is seen to be in octahedral 
crystals. But this reagent will also precipitate ammonice ; 
hence, in an analysis, the absence of the latter alkali must 
be insured. Ammonia can readily be detected by heating a 
little of the suspected liquid in a test-tube with hydrate of 
lime ; the vapor may be recognized by its odor, and by its 
action on turmeric paper. 

(2) Tartaric acid throws down from a strong solution of 
potassa, or its salts, a white crystalline precipitate (cream 
of tartar). This action may be facilitated by adding a little 



218 TOXICOLOGY. 

alcohol, and by stirring with a glass rod. Here, also, the 
absence of ammonia must first be proved. 

(3) Neutralize each alkali with nitric acid, and evaporate 
the solutions. The resulting crystals are readily distin- 
guishable. The potassic nitrate {iiitre) is in six-sided, striated 
crystals ; the sodic nitrate is in cubes. 

(4) Heated on a platinum wire, in the blowpipe flame, 
potassa gives a znolet color ; soda, a yellow one. 

(5) Antimoniate ^ /^/^5^^ (freshly prepared) yields with 
soda and its salts, a white crystalline antimoniate of soda. 
This reagent gives no precipitate with potassa or ammonia; 
but is affected by several of the metallic salts. 

(6) The spectrum process is an exceedingly delicate test 
for either soda or potassa, giving with the former a well- 
defined j^/^w band, and with the latter two lines, one in the 
yellow, and one in the blue space. 

(7) Polarized light affords a most delicate test for soda. 
A drop or two of the solution, to which a drop of hydro- 
chloric acid has been added, is put upon a glass slide, and 
a drop of the solution of bichloride of platinum is then 
added, avoiding an excess. The mixture is next to be care- 
fully evaporated, until it begins to crystallize ; it is then 
placed under the microscope, furnished with a polarizer. 
On turning the analyzer until the field becomes perfectly 
dark, the crystals exhibit a beautiful play of colors ; whilst, 
if no soda is present, no effect is produced. According to 
Prof Andrews, siAoo of a grain may be thus detected (Chem. 
Gaz. X, p. 378). 

Toxicological examijtation. — The mixture will usually have 
a soapy feel and frothy appearance. The absence of am- 
monia should first be established {ante. p. 217). Evapo- 
rate to dryness, and heat to redness in a capsule, in order 
\ 



TESTS FOR SALTS OF AMMONIA. 219 

to char the organic matters. The ash is then to be digested 
in distilled water and filtered ; the alkali will be found in 
the solution as a carbonate, when it may be tested as above 
described. 

If required to separate the caustic alkali from the carbo- 
nate that may be present in the original mixture, the latter 
must first be evaporated to dryness, and the residue treated 
with absolute alcohol, which will dissolve out the free alkali, 
but not the carbonate. After filtration, evaporate to dry- 
ness and incinerate ; dissolve the residue in water, and test 
as above directed. 

Quantitative determinatiojt. — Potash is estimated as a 
double chloride with platinum {ante, p. 217). The precipi- 
tate should be washed with strong alcohol, dried and 
weighed. Every 100 parts of the double chloride represent 
22.5 parts of caustic potassa, or 28.25 parts of anhydrous 
carbonate. 

Chemical analysis of Ammonia and its salts. — Solution of 
ammonia {aqua, or liquor ammonicB) is a colorless liquid, 
having a very pungent odor, and an acrid, alkaline taste. 
When heated it evolves gaseous ammonia. It leaves no 
residue when evaporated to dryness. It gives to a solution 
of a copper salt a characteristic purple color. 

The salts of ammonia are colorless, and volatilize when 
heated; and if, at the same time, they are mixed with lime 
or potassa, they yield the characteristic ammoniacal odor. 
The other tests for the salts of ammonia are — (i) bichloride 
of platinum; (2) tartaric acid ; (3) carbazotic (or picric) acid; 
(4) Nessler's test — this consists of adding an excess of iodide 
of potassium to corrosive sublimate until the mercuric iodide 
formed is redissolved, an excess of free potassa being added; 
it gives a broivn discoloration with the smallest trace of 
ammoniae. 



220 TOXICOLOGY. 

Toxicological exaniinatio7i. — If the mixture be in a state 
of decomposition, it will be useless to attempt the analysis, 
inasmuch as ammonia is a result of the putrefactive process. 
Unless it be found in very small quantities, the characteristic 
odor will determine its presence. Distill over about a fourth 
of the organic liquid, conducting the vapors into a well- 
cooled receiver, containing a little water, and test the solu- 
tion as above directed. If no ammonia be given off, then 
examine the contents of the retort for an ammoniacal salt, 
by first treating with strong alcohol ; filter the solution, and 
re-distill, along with hydrate of lime or potassa; this will 
yield the free ammonia. 

Ammonia is determined, quantitatively, like potassa : 
every lOO parts of the double chloride represent 7.62 parts 
of pure ammonia. 

SECTION II. 
POISONING BY THE ALKALINE AND EARTHY SALTS. 

NITRATE OF POTASSIUM. — BITARTRATE OF POTASSIUM. — SULPHATE OF 
POTASSIUM. — ALUM. — CHLORINATED POTASS^ AND SODA. — SALTS 
OF BARIUM. 

Nitrate of Potassium (Nitre ; Saltpetre^. — This salt is much 
used in the arts, especially for the manufacture of gun- 
powder; it is likewise employed in medicine, in small doses. 
It occurs in six-sided, striated crystals ; taste saline and 
cooling; very soluble in water; deflagrates when thrown 
upon hot coals ; gives off nitrous fumes when acted upon 
by sulphuric acid. 

Symptoms. — In large doses, and in the concentrated state, 
it acts as a powerful irritant to the alimentary mucous 
membrane, causing violent burning pain in the gullet and 
stomach; vomiting, sometimes of blood; bloody stools; 
cold, clammy skin ; weak, frequent pulse ; collapse and 



POISONING BY NITRE. 221 

death. Besides these evidences of a local irritant action, it 
occasions certain nervous symptoms, such as convulsions, 
tremors, partial paralysis, loss of speech and delirium. 
Occasionally, a very large dose has produced comparatively 
slight local symptoms, while the impression upon the 
nervous centres has been more decided. 

Fatal dose. — Death from this salt is generally the result 
of accident, it having been swallowed by mistake for other 
salts. An ounce to an ounce and a half taken in a concen- 
trated state, has frequently proved fatal in a few hours. The 
largest dose recorded to have been taken is mentioned by 
Wharton & Stille {Med. Juris p. 1884, ii, p. no). A Ger- 
man, by mistake, swallowed three and a half ounces of this 
salt. He complained of but slight pain or sense of heat in 
the stomach, and was purged three times within three or 
four hours. About five hours after taking the nitre, he 
suddenly fell out of his chair and expired. There was no 
autopsy. In this case, the excessive dose of the poison 
seemed to have destroyed life by shock. The rigor mortis 
was very imperfect, and the countenance and lips retained 
their life-like appearance to a remarkable degree for three 
days after death. 

Post-mortem appearances. — The lining membrane of the 
stomach is usually highly inflamed, and detached in places; 
perforation has been observed in one instance. The intes- 
tines are often similarly affected. The contents of the 
stomach are sometimes tinged with blood. 

Treatment. — Free vomiting should be promoted by the 
use of bland mucilaginous drinks ; opium and stimulants, 
to relieve pain and depression ; together with external appli- 
cations, as fomentations, etc. There is no chemical anti- 
dote. 



222 TOXICOLOGY. 

Toxicological examination. — See Nitric Acid, p. 208. — Ac- 
cording to Orfila and Wohler, nitre has been detected 
in the urine, liver, spleen and kidneys of those poisoned 
with it. 

Bitartrate of Potassium {^Cream of Tartar). — This salt is 
very much used in medicine, and is not generally considered 
to be poisonous ; but in large and concentrated doses — two 
ounces — it has proved fatal, causing symptoms strongly 
resembling those produced by nitre. 

Alum {^Sulphate of Alumimun and Potassiuni). — This salt, 
in large doses, is very irritant to the stomach and bowels, 
producing vomiting and purging, although in small quanti- 
ties its action is that of an astringent. It has proved fatal 
to animals, but no death in the human subject has been 
recorded. 

Sulphate of Potassium^ like the foregoing salts, is highly 
irritating in large doses. It has occasioned death in the 
quantity of ten drachms and upwards. It is used sometimes 
as an abortive, and with fatal results. Arsenic has at times 
been found as an impurity in this salt, derived, doubtless, 
from an impure sulphuric acid used in its manufacture. 
Arsenic, in this way, might find its way into Dover's powder, 
etc. It would be proper to test for arsenic in any sample of 
this salt which causes irritation. 

Large doses of the ordinary purgative salts, under certain 
circumstances, may prove powerfully irritating, and even 
fatal. Instances of death following the administration of 
overdoses of Epsom salt and common salt are reported by 
Christison and Taylor. 



POISONING BY SALTS OF BARIUM. 223 

Chlorinated Soda and Potash. — Known in commerce as 
Bleaching Salts, and much used in France for cleansing 
clothes, have occasionally produced fatal effects when swal- 
lowed. Tardieu has reported such a case [Sur V Enipoisonne- 
meni), where a child died some weeks after taking this sub- 
stance in divided doses. It was identified by the discovery of 
an abnormal quantity of chloride of sodium in the urine and 
kidneys; also, by the formation of chloride of lead on the 
leaden mouth-piece of the bottle which contained the poison, 
and likewise by characteristic stains of a reddish-white 
color on the child's cap. 

Salts of Bariiun. — All the compounds of barium (with 
the exception of the insoluble stilphate) are poisonous. 
They occasion symptoms very analogous to those caused 
by nitrate of potassium, such as pain in the stomach, 
vomiting and purging, with decided nervous symptoms, and 
palpitation of the heart. The post-mortem lesions are inflam- 
mation of the mucous coat of the stomach and bowels, great 
congestion of the brain and lungs, and the heart full of dark 
blood. 

The proper treatment is to promote the evacuation of the 
poison by the use of emetics and mucilaginous drinks, and 
the free administration of sulphate of sodium, or magnesium, 
and the subsequent use of antiphlogistic remedies. 



224 TOXICOLOGY. 



CHAPTER XVL 

ORDER II.— IRRITANTS POSSESSING REMOTE SPECIFIC 
PROPERTIES. 

This subdivision of the Irritants includes such poisons 
embraced under Class I as, besides producing inflammation 
of the gastro-intestinal mucous membrane, cause other 
symptoms, which indicate an impression on the great 
nervous centres. Several of the alkaline and earthy salts 
already described are of this character, and might very 
properly have been considered under this head, but they 
were more conveniently discussed in connection with the 
Alkalies. 

SECTION I. 

POISONING BY PHOSPHORUS. 

SYMPTOMS. — FATAL DOSE. — TREATMENT, — MORBID APPEARANCES. — 
DIAGNOSIS. — CHEMICAL ANALYSIS.^-AMORPHOUS PHOSPHORUS. 

Phosphorus, in combination, is largely diffused as a con- 
stituent of the animal body. Its presence is essential to the 
performance of its normal functions, and this is especially 
true in reference to the great nerve centres, of which it con- 
stitutes a comparatively large proportional part. It is 
eliminated from the system in the urine, in the form of 
phosphates. 

In lis free state, phosphorus is a powerful irritant poison. 
It is less employed for poisoning in this country than in 
Europe, and is seldom used for homicidal purposes. Fatal 
results have frequently occurred by its accidental and 
suicidal employment — chiefly the former — from the swallow- 



PHOSPHORUS FATAL DOSE. 225 

ing- of phosphorus-paste (used for destroying vermin), and 
the tops of lucifer matches. 

Symptoms. — These do not usually appear for some hours 
after the poison has been taken. There is first perceived a 
disagreeable, garlicky taste, and an alliaceous odor may 
often be noticed from the breath. This is followed by a 
burning pain in the throat and stomach, with intense thirst 
and nausea, distention of the abdomen, with vomiting and 
purging ; pupils dilated ; cold perspiration, and great anxiety, 
with small, frequent and irregular pulse. The matters first 
vomited generally exhale an alliaceous odor, and are 
luminous in the dark ; their color is dark green, or like 
coffee grounds. The discharges from the bowels have also 
been observed to be phosphorescent. Sometimes convul- 
sions precede death ; again, the patient may die quietly, or 
in a coma. If the case is protracted for some days, jaundice 
is apt to occur, and likewise hemorrhage from the stomach, 
bowels, nose and other parts of the body. Paralysis is an 
occasional result. The urine is highly albuminous. 

Chronic poisoning-, accompanied with all the above symp- 
toms, though in a less violent degree, may result from the 
inhalation of the vapors of phosphorus in the manufacture 
of lucifer matches. This form of poisoning comes on very 
insidiously, and is very apt to be fatal. It generally mani- 
fests itself first in the jaws, causing caries of the teeth and 
necrosis of the bone. Some authorities state that this form 
of necrosis cannot attack those who have perfectly sound 
teeth, but only those whose teeth are carious {St. Earth. 
Hosp. Reports, vol. XII). And it is further stated that in 
some match factories it is required that the workmen should 
have sound teeth. 

Fatal dose. — Less than a grain has proved fatal, A child 
died after sucking two matches ; another older child died from 
II 



226 TOXICOLOGY. 

the effects of swallowing the tops of eight matches. Dr. 
Taylor mentions the case of a lunatic who died from swal- 
lowing one-eighth of a grain (On Poisons^ p. 315). 

Phosphorus is occasionally employed in medicine, in doses 
of eV to sV of a grain; but even in these small doses its 
effects are uncertain, and it may sometimes act with unex- 
pected severity. 

Fatal period. — It is not to be classed among the rapidly 
fatal poisons. It usually causes death in from one to four 
or five days ; in exceptional cases, earlier. Casper quotes 
the case of a young lady who died in twelve hours after swal- 
lowing three grains of phosphorus in the form of an electuary 
(Foren. Med., II, p. 100). Dr. Habershon reports a case which 
proved fatal in half an hour. Cases of chronic poisoning 
may last for months, or even for years. 

Treatment. — There is no chemical antidote known. Free 
emesis should be encouraged by the use of albuminous and 
mucilaginous drinks holding hydrate of magnesia in sus- 
pension. The use of oil is objectionable, as this is a solvent 
for phosphorus, and would consequently tend to diffuse the 
poison. Oil of turpentiiie is highly recommended by Dr. 
Percy (Prize Essay, 1872) as a reliable antidote, if given 
early, and before the poison is absorbed. The old oil, or 
that which has become oxygenated, is to be employed, not 
the fresh hydrocarbon. He also recommends the introduc- 
tion of oxygenated water into the stomach, through a tube, 
and the inhalation of free oxygen into the lungs. 

Animal charcoal has also been recommended, from its 
power of absorbing free phosphorus, and likewise intrate of 
silver, from its power to form an insoluble compound of 
silver and phosphorus [Brit, ajid For. Med.- Chir. Rev., 1870). 

It has been supposed by some that the poisonous effects 
of phosphorus are owing to its conversion into phosphorous 



PHOSPHORUS POST-MORTEM LESIONS. 227 

acid, at the expense of the oxygen of the blood ; but there 
is good evidence to show that it is absorbed and eHminated 
uncombined, as the urine has been observed to be luminous. 
It is more probable that it acts as a blood poison. The 
blood corpuscles undergo a speedy disintegration, which is 
doubtless the cause of the ecchymoses seen upon the differ- 
ent organs. 

Post-mortem appearances. — According to Tardieu (Siir 
V Empoissonement, p. 437), who has given special attention 
to this subject, the lesions produced by phosphorus vary 
according to the form in which it is taken. It is when in 
the pure state, or simply dissolved in oil, that it most fre- 
quently occasions lesions in the oesophagus and alimentary 
canal. Fragments of phosphorus may be discovered ad- 
hering to the mucous membrane, even of the large 
intestines, and at these spots the bowel is liable to perfora- 
tion during the examination. In the oesophagus, stomach 
and intestines, ecchymotic or gangrenous spots are scat- 
tered about. The mesenteric glands are engorged, and 
often soft and friable. 

In other cases, as in poisoning by phosphorus-paste, there 
may be no special morbid appearance, but even in the 
absence of redness or ulceration, there will be ecchymoses, 
more or less abundant, over the mesentery and visceral peri- 
toneum. The pleural and pericardial sacs contain bloody 
serum. Irregular bloody spots are scattered over the pleura, 
pericardium, and even the endocardium. The heart is soft, 
distended, or contains fluid blood. The blood itself is very 
dark, fluid, and syrupy ; it appears to be completely devital- 
ized ; the corpuscles are disintegrated and transparent, by 
loss of their coloring matter. In certain cases, the mucous 
coat of the stomach and duodenum is so softened as to 
break under pressure of the knife ; ulcerations, also, some- 



228 TOXICOLOGY. 

times occur in the stomach. It is stated that the in- 
testines, and even the flesh, of animals poisoned by 
phosphorus have the odor of garhc, and appear luminous 
in the dark. 

This luminosity of the viscera has been observed in the 
human subject. 

The exterior of the body often exhibits an icterode ap- 
pearance. Sometimes, the red or blue coloring matter of 
the lucifer matches that have caused death may be found 
adhering to the inside of the alimentary canal, a considerable 
time after death. The general appearance of the gastro- 
intestinal mucous membrane is hemorrhagic rather than 
inflammatory, ecchymoses being scattered throughout. The 
contents of the intestines are liquid and bloody. The 
bladder contains bloody urine, and often presents sub- 
mucous ecchymoses. 

A peculiar pathological alteration, revealed by the micro- 
scope as the result of phosphorus- poisoning, is fatty degen- 
eratiofi of the liver ^ and other organs of the body. But these 
peculiarities are not absolutely characteristic of this poison- 
ing, since they occur in poisoning by other agents, as 
ammonia, arsenic, alcohol, antimony, etc., and also as the 
result of disease ; nevertheless, they possess especial im- 
portance from their association with other notable symp- 
toms of phosphorus-poisoning, such as the jaundice, mus- 
cular pains and weakness, diseased condition of the blood, 
and albuminous urine. 

The contents of the stomach in some instances evolve the 
odor and white fumes of phosphorus; and in a case men- 
tioned by Casper, two days after death luminous vapors 
issued from the vagina, and a whitish vapor having a phos- 
phorous odor issued from the anus. In this instance, no 
smell, or vapor of phosphorus could be detected on opening 



PHOSPHORUS CHEMICAL ANALYSIS. 229 

the stomach ; nor was there any part of its lining mem- 
brane either softened or corroded. 

Diagnosis. — Generally, in acute cases, there will be no 
difficulty in recognizing the evidences of phosphorus-poi- 
soning, both from the symptoms and post-mortem lesions, 
as above detailed. Chronic cases, accompanied by jaun- 
dice, might, however, be mistaken for yellow atrophy of the 
liver. The following are diagnostic points : The sensation 
of heat in the throat, eructations and vomiting of matters 
having a garlicky odor and a luminous appearance, would 
indicate phosphorus poison. The icterode appearance is 
not so intense in the poisoning as in the disease, nor is it 
accompanied with the injection of the eyes, or with the fever, 
which mark the latter. The fatty change of the viscera 
may be seen tivo days after the ingestion of the poison 
(Tardieu). According to other authorities, the liver in 
phosphorus-poisoning is enlarged, of a dull appearance, 
doughy, uniformly yellow, with the acini well marked ; in 
acute atrophy, the liver is diminished in size, greasy on the 
surface, of a dirty yellow color, and the acini nearly 
obliterated. In the former, also, the hepatic cells are either 
filled with oil globules, or entirely replaced by them ; in the 
latter, the cells are filled with a fine granular detritus and 
thin structure, replaced by a newly-formed connective 
tissue (Husband). 

Chemical analysis. — Phosphorus is a white, waxy solid ; 
sp. gr. 1.83; fuses at iio° F. ; at a higher temperature it 
takes fire, burning with a brilliant white light, becoming 
converted into the white fumes of anhydrous phosphoric 
acid. It evolves white fumes of phosphorous acid at ordinary 
temperatures, when exposed to the air, which also appear 
luminous in the dark. The smell and taste of phosphorus 
resemble those of garlic, by which means it may be easily 



230 TOXICOLOGY. 

recognized when mixed with food and drinks. The fuming 
of phosphorus in the air, as also its luminosity, is completely 
prevented by the presence of alcohol, ether, chloroform, oil 
of turpentine and ammonia, even in minute quantities. 
Although insoluble in water, phosphorus imparts to it 
poisonous properties, from the production of phosphorous 
acid. It is tolerably soluble in fixed and volatile oils, by 
the aid of heat ; also in ether, chloroform and naphtha ; its 
best solvent is bisulphide of carbon. Nitric acid converts it 
into phosphoric acid. It is not affected by either sulphuric 
or hydrochloric acids. It is best preserved under water, to 
protect it from oxidation. 

In its free state, phosphorus is easily detected by its 
sensible properties, as already described. A fragment put 
into the materials for generating hydrogen will evolve pJios- 
plwretted hydrogen, easily recognized by its luminosity in the 
dark, and from being sometimes spontaneously inflammable; 
this gas, when ignited at a jet, burns with a greenish-blue 
flame. When it is passed through a solution of nitrate of 
silver, the latter is blackened by the production of metallic 
silver, and phosphoric acid is formed in the solution, and 
may be detected by the appropriate reagents. 

Toxicological examination. — If the materials evolve whitish 
fumes, which are luminous in the dark and have an allia- 
ceous odor, there can be no doubt of the presence of phos- 
phorus. If the mixture be ammoniacal, from putrefaction, 
sulphuric acid must first be added, to neutralize the ammo- 
nia, since this would prevent the display of luminosity. 
Sometimes the particles of phosphorus may be separated 
mechanically from the inside of the stomach and bowels, 
which, when found, should be carefully washed and set 
aside. Or, the mass may be spread out on a metallic plate, 
and gently heated over a spirit lamp, when the minute frag- 



PHOSPHORUS TOXICOLOGICAL EXAMINATION. 231 

ments of phosphorus will take fire and burn with a brilliant 
light. The suspected particles may be heated under water, 
when they will melt and run together into a globule, which 
will solidify on cooling, and may easily be identified. 

Bisulphide of carbon may be used to dissolve out the 
phosphorus from many organic mixtures, as when phos- 
phorus paste has been employed. On allowing the solution 
to evaporate spontaneously, the phosphorus will remain in 
minute globules, which can readily be examined. If, how- 
ever, the poison is in solution, or in too minute a quantity 
for the above tests, it must be examined by the following 
processes : — 

Method of MitscherlicJi. — The suspected liquid, acidified 
by sulphuric acid, is to be distilled in the dark, and the 
vapors conducted through a long glass tube, kept cold, the 
end of which passes into a receiver. On gently heating the 
retort or flask, the vapors, as they pass through the cold 
tube, condense and display a distinct luminosity. The phos- 
phorus thus distilled collects with the aqueous vapor in 
the receiver, to which it imparts the usual garlicky odor. 
A portion of it may likewise collect in the receiver in the 
form of globules. This test is exceedingly delicate and 
satisfactory. Dr. Taylor states that the head of one lucifer 
match produced a luminosity which continued for half an 
hour, in the condensing tube. We have ourselves verified 
this, by experimenting with a granule containing the uV of a 
grain of phosphorus, with satisfactory results. 

The presence of solid phosphorus in the distillate would 
render further experiments unnecessary ; but in the absence 
of any granules, the distillate, after filtration, should be 
acidified by nitric acid, which will convert any phosphorus 
into phosphoric acid; the liquid should then be concentrated 
by evaporation, and tested (see post}) If no luminosity has 



9.?.-2 



TOXICOLOGY. 



been observed, the presence of a small amount of the 
oxides of phosphorus in the distillate is not sufficient to 
warrant the supposition of poison, since these might have 
been derived from the food or tissues, and carried over 
mechanically. It should be remembered that it is only 
free phosphorus that gives out the luminosity by the 
above process; the distillation of the brain, or any other 
tissue that contains this substance in combination^ never 
produces it. 

MetJiod of Lipozvitrj. — This consists in boiling the sus- 
pected liquid, slightly acidulated with sulphuric acid, with 
fragments of sulphur, in an apparatus similar to that em- 
ployed in the method of Mitscherlich, the experiment being 
conducted in the dark. The sulphur abstracts the phos- 
phorus from even complex mixtures, and combines with it. 
The boiling is continued for about half an hour, after which 
the pieces of sulphur are withdrawn and washed in water. 
They will now emit the peculiar odor of phosphorus, and 
appear luminous in the dark. On gently heating them 
with nitric acid, a mixture of phosphoric and sulphuric acids 
will result. By evaporating this solution to near dryness, 
to get rid of the sulphuric acid, then diluting and filtering, 
the phosphoric acid may be recognized by the usual tests. 
In prosecuting this test, unless the amount of phosphorus 
is very minute, the luminosity of the vapor may also be ob- 
served in the cool tube. 

The hydrogen niethod. — This process resembles the 
method of Marsh employed in arsenic testing. The sus- 
pected material, properly prepared, is put into the jar con- 
taining the materials for generating hydrogen ; the resulting 
gas is then passed over hydrate of lime, for the purpose of 
removing any sulphuretted hydrogen; it is then ignited at 
the end of the delivery tube, producing 2, green flame. The 



PHOSPHORIC ACID TESTS. 233 

phosplioretted hydrogen is luminous in the dark, and affords 
a black precipitate with nitrate of silver. 

Phosphorus has been detected in the free state as late as 
fourteen days, and three weeks after death; but it is very 
apt soon to become oxidized in the body, in which case it 
can only be identified as phosphoric acid. 

The method of testing for phosphorus, or phosphoric acid, 
in a case of suspected poisoning, is very unsatisfactory, since 
this acid exists in combination with the tissues and secre- 
tions, as well as in many articles of food. 

The mode of procedure in such a case is to treat the 
mixture with a little pure nitric acid, and concentrate by 
evaporation. It is then treated with a slight excess of pure 
carbonate of sodium and evaporated to dryness, and fused 
in a porcelain crucible. The resulting phosphate of sodiiini 
may then be tested as follows : — 

(i) Nitrate of silver throws down a yellow tribasic phos- 
phate of silver, soluble in ammonia, and in nitric and acetic 
acids. Hydrochloric acid converts it into the zuhite chloride. 
Nitrate of silver also gives a yellow precipitate with arsenious 
acid, which behaves in the same manner as the phosphate ; 
they are distinguished by drying, and heating in a reduction 
tube ; the arsenic yields a ring of sublimed octahedral crys- 
tals (vid. post^ 

(2) Ammonio-sidphate of magnesia. — This compound 
gives with a phosphate a characteristic crystalline precipi- 
tate — the aininonia-pliospJiate of magnesia; the minutest 
quantity can be identified by the microscope. 

(3) Molybdate of ammonia. — This reagent produces a 
yellow, pulverulent precipitate — the pliospho-molybdate of 
ammonia; it is insoluble in the strong acids, but soluble in 
alkaline phosphates, alkalies and alkaline carbonates. 

Red, Amorphous, or Allotropic Phosphorus. — This singular 
II* 



234 TOXICOLOGY. 

variety of phosphorus is procured by exposing ordinary 
phosphorus to a heat of 450° F., in an atmosphere deprived 
of oxygen (as in carbonic acid gas) for a number of hours, 
when it will have changed into a hard, brick-red mass, 
totally unlike the ordinary substance in its chemical, phy- 
sical and physiological properties, although retaining its 
original chemical composition. The difference between the 
two is shown by reference to the following table, taken from 
Dr. Percy's essay above referred to : — 

COMMON PHOSPHORUS. RED PHOSPHORUS. 

Poisonous. Innocuous. 

Evolves a strong odor. Nearly odorless. 

Phosphorescent. Not phosphorescent. 

Melts at 108° F. Melts at about 500° F. 

Transparent. Opaque. 

Almost colorless. Varies in color from a reddish- 

black to crimson. 

Freely soluble in various liquids. Nearly insoluble with liquids. 

Distinctly crystalline. Amorphous. 

Soft and waxy. Hard as red brick. 

Flexible. Brittle as glass. 

Oxidizes in the air. Unalterable in the air. 

Unites readily with other elements. Is acted on by other elements with 

difficulty. 

Nitric acid acts on it with great Produces no effect, 
energy. 

SECTION II. 
POISONING BY IODINE, BROMINE AND CHLORINE. 

Iodine occurs in shiny, dark iron-gray scales; it has a pe- 
culiar odor and disagreeable taste; when heated it gives off 
beautiful violet-colored fumes, which are irritating to the 
nostrils and throat. Sparingly soluble in water, very 
soluble in alcohol and ether, and also in the aqueous 



POISONING BY IODINE. 235 

solution of iodide of potassium. It is used medicinally in 
the form of tinctwe, compound tincture and ointme7it. 

Symptoms. — Like phosphorus, iodine produces a local 
irritant effect, and a remote influence; the latter, the result 
of using it in small quantities. In large doses it occasions 
burning heat in the throat; severe pain in the abdomen; 
vomiting and purging, the vomited matters having the pe- 
culiar odor of iodine, sometimes mixed with blood ; the 
color of the matters is yellowish, except when they consist 
of farinaceous articles, in which case it is blue. The bowels 
may also exhibit the presence of iodine. Other symptoms are 
giddiness, headache, thirst, anxiety, convulsions and fainting. 

In chronic poisoning (iodism) the symptoms are nausea, 
vomiting, purging, pain of stomach, tremors, palpitation, 
salivation, cramps, general emaciation, and a tendency to 
absorption of certain glands, especially the testes of males, 
and the mammae of females. 

There is a remarkable diversity in the effects of iodine 
upon the human system, some persons bearing very large 
doses with little or no suffering, while others are seriously 
affected by the smallest quantities. Overdoses have occa- 
sionally proved fatal, leaving morbid appearances very 
similar to those produced by the irritant alkaline salts. 

Chemical analysis. — In its free state, iodine may readily 
be distinguished by its solid form, color, odor, volatility, and 
its action on boiled starch — quickly turning it blue. In 
combination, as iodide of potassium, the iodine must first be 
set free (by chlorine, or nitric acid) and then the starch-test 
applied. 

From organic mixtures the iodine may be separated by 
bisulphide of carbon, which dissolves it, forming a pink 
solution ; rem.ove the watery liquid, and evaporate the 
bisulphide solution to dryness, when the iodine will be left. 



236 TOXICOLOGY. 

If this process fails, on account of the conversion of the 
iodine into hydriodic acid, or into an iodide, it will be 
advisable to transmit sulphuretted hydrogen through the 
mass, properly diluted ; this will convert any free iodine to 
hydriodic acid ; drive off the excess of gas by heat ; add 
potash in excess ; filter and evaporate to dryness. Char the 
residue at a low red heat, to get rid of the organic matter ; 
pulverize and dissolve in water. Concentrate the solution, 
and add strong nitric acid and boiled starch, which will 
develop the iodine, if any be present. 

Iodide of Potassium. — Although much used in medicine, 
in doses up to sixty grains it occasionally produces violent 
effects upon the system, such as headache, griping abdomi- 
nal pains, thirst, inflammation of the nostrils and eyes, and 
frequent pulse, together with salivation, and a pustular 
eruption. As found in the shops, the salt is apt to be con- 
siderably adulterated with the carbonate. 

Bromine. — This is a dark red, volatile liquid, excessively 
pungent to the eyes and respiratory organs, having an acrid 
odor and taste. It is highly corrosive, destroying animal 
tissues very rapidly. It has occasionally proved poisonous 
fatally. A case is reported by Dr. Sayre, of New York, of 
a daguerreotyper, who swallowed an ounce of bromine for 
the purpose of self-destruction. The immediate symptoms 
were spasmodic action of the muscles of the larynx and 
pharynx, with great difficulty of breathing, followed by in- 
tense burning pain in the stomach, with great anxiety, rest- 
lessness and trembling of the hands. The pulse was rapid, 
tense and corded, and respiration greatly hurried. Collapse 
soon followed, and death took place in seven and a half 
houi's after swallowing the poison. 

The post-mortem examination revealed vivid injection of 



POISONING BY BROxMlNE AND CHLORINE. 237 

the external coat of the stomach and of the abdominal 
viscera generally, which were stained of a deep yellow 
color. Portions of the stomach were softened. Its con- 
tents resembled port-wine dregs, and exhaled the odor of 
bromine. Its whole interior was covered with a thick black 
layer resembling coarse tanned leather. The mucous mem- 
brane was very thin and very deeply injected (Whar. and 
Stille's Med.Jurisp. from N. York Jour, of Med , Nov. 1850). 
Chemical analysis. — Bromine may be separated from 
organic matters by means of bisulphide of carbon, or by 
ether, after the method described for iodine (p. 235). The 
bromides may be decomposed by chlorine, or by a strong 
acid. Bromine is characterized by imparting a deep yellow 
color to boiled starch. 

Chlorine is a powerfully irritating gas, of a greenish - 
yellow color. If inhaled into the lungs it may destroy life, 
like gaseous ammonia. Chlorine is readily recognized by 
its smell and color, and especially by its powerful bleaching 
properties. 



238 TOXICOLOGY. 



CHAPTER XVII. 

POISONING BY ARSENIC. 

METALLIC ARSENIC. — ARSENIOUS ACID. — PROPERTIES. — SYMP- 
TOMS. — CHRONIC POISONING. — FATAL DOSE. — TREATMENT. — POST- 
MORTEM SIGNS. — CHEMICAL ANALYSIS. — TOXICOLOGICAL EXAMI- 
NATION. — OTHER PREPARATIONS OF ARSENIC. 

The term arsenic, as employed in toxicology, always 
signifies (unless specially qualified) arsenious acid, or white 
oxide of arsenic. The metal is brittle, of a steel-gray color, 
very volatile when heated, its vapor having a strong, garlicky 
odor, by which it is easily recognized. It is very rarely 
used as a poison ; it is sold, however, under the name oifiy 
pozuder, which is a mixture of the metal and arsenious acid. 

Arsenic is one of the most important of all the poisons. 
The facility of procuring it, and its ease of administration 
contribute greatly to its extensive use, both as a homicidal 
and suicidal agent. Arsenic exists in nature in the form of 
the metal, and in combination with other metals, particularly 
iron, copper, zinc, nickel and cobalt ; also with sulphur, as 
native orpiinent and realgar. 

In the arts, arsenic enters into numerous compounds, as 
in the manufacture of enamel and glass, composition can- 
dles, vermin killers, etc. It is used by shipbuilders to pro- 
tect timber from worms ; by farmers to preserve their grain 
for seed and for washing sheep ; by grooms to improve the 
coats of their horses ; and, if we may credit the accounts of 
travelers, by the inhabitants of Styria and other mountain- 
ous countries, to increase their physical powers of endurance 
and to improve the complexion of the females. 



POISONING BY ARSENIC SYMPTOMS. 239 

Properties of Arseniozis Aeid, AsOs. — It occurs in com- 
merce either as a heavy, white powder, or in masses, which 
are at first translucent, but afterwards become opaque. It is 
nearly tasteless, or at most has a faint sourish taste, not 
acrid. It is only slightly soluble in cold water ; boiling 
water dissolves about the eighteenth to the fortieth part of 
its weight, or from six to twelve grains to the ounce. Cold 
water takes up only about half a grain to the ounce. Its 
solubility is much increased by the addition of an alkali, but 
diminished by the presence of organic matter. It is easily 
held in suspension by soups, coffee, tea, milk, etc. 

When arsenious acid is heated at a temperature near 400° 
F., it sublimes in the form of a white vapor, which is 
inodorous, and is deposited on a cool surface, either as an 
amorphous powder, or in octahedral crystals. If thrown 
upon red-hot charcoal it is decomposed, and the vapor will 
have an alliaceous odor, because it results from the reduced 
metal. 

Symptoms. — The rapidity and virulence of the symptoms 
depend somewhat on the form of the poison (i. e., whether 
in solution or otherwise), and also on the fullness or empti- 
ness of the stomach. As a rule, the symptoms do not 
occur for half an hour, or an hour. There is first a sense of 
faintness, attended with a feeling of heat and constriction of 
the throat, together with thirst, nausea and burning pain in 
the stomach, increased by pressure. Vomiting and retch- 
ing soon follow ; the matters ejected are sometimes streaked 
with blood ; they may be variously colored. Purging, 
accompanied with tenesmus, comes on, and along with the 
vomiting, may be incessant, though affording no relief to 
the sufferer. Cramps in the legs are apt to be present, 
along with great depression, cold sweat, intense thirst, and 
a feeble, frequent pulse. The whole train of symptoms 



240 TOXICOLOGY. 

strongly resembles a severe case of cholera morbus, for 
which it has frequently been mistaken. As a rule, the 
symptoms are continuous, although there are, occasionally, 
remissions, and even intermissions. Coma, paralysis and 
convulsions may supervene before death. The urine is often 
partially suppressed. If the patient recovers from the im- 
mediate attack, he may suffer for a long time after from 
indigestion, partial paralysis, or from epilepsy. 

Certain anomalies may occur. The pain may be absent or 
slight. Vomiting and purging and thirst may not be 
present. Some cases especially resemble cholera morbus, 
from the intensity of the gastro-enteric irritability ; whilst 
others indicate severe nervous disturbance, by the intense 
headache, giddiness, restlessness, violent cramps, delirium, 
convulsions and coma. Again, there may be immediate 
collapse, little or no pain, vomiting or purging, but a cold, 
clammy skin, extreme prostration, very frequent and feeble 
pulse, slight coma, with perhaps convulsions and death 
within a few hours after swallowing the poison. In yet 
other instances, the symptoms resemble those of narcotics, 
the person falling into a profound sleep, deepening into 
coma, and dying in a few hours without rallying. In the 
latter cases, the autopsy has revealed no trace of inflamma- 
tion of the stomach. 

All the above varieties of symptoms occur quite inde- 
pendently of the size of the dose, or mode of administration, 
and they cannot be satisfactorily explained except by 
referring them to constitutional peculiarities. 

The symptoms of chronic poisoning usually result from 
small doses of arsenic frequently repeated, or from exposure 
to the vapors of arsenical products, as in the case of work- 
men, or from the accidental inhalation of arsenical dust 
from wall papers. The eyes become inflamed and watery. 



ARSENIC EXTERNAL APPLICATION. 241 

there Is great gastric distress, with frequent sickness and 
vomiting, diarrhoea, headache and giddiness, a jaundiced 
skin, an eczematous eruption, local paralysis, general 
emaciation, falling out of the hair, salivation and excoria- 
tion of the tongue, with hemorrhage; and death may occur 
from exhaustion. The symptoms in such a case are fre- 
quently very obscure and misleading, and perhaps chance 
alone may reveal the real source of the disorder. 

The time when the symptoms appear varies considerably. 
As before stated, these do not generally manifest themselves 
for a half hour or an hour after swallowing the poison, but 
there are numerous exceptions. Cases are recorded where 
they appeared in the act of sivallozviiig ; others, in which 
they were exhibited in eight, ten and fifteen minutes after. 
On the other hand, numerous instances are recorded where 
the time was protracted for many hours. The longest in- 
terval is mentioned in the U. S. Dispensatory (1865), where 
the symptoms were delayed for sixteen hoiirs^ after a dose of 
a drachm of the poison. This discrepancy may, in part, be 
accounted for by the state of the stomach, it being empty 
or full at the time of administration ; also by the form of 
the dose, whether solid or liquid ; also by the time of 
day, whether before going to sleep, or otherwise. The 
simultaneous use of opium or alcohol would, no doubt, 
exercise a modifying influence over this poison. (See ante, 
p. 186.) 

The external application of arsenic, either to the sound 
skin, or still more to abraded or ulcerated surfaces, is often 
followed by fatal results. Proofs of this are exhibited in the 
effects of the applications of cancer-curers to ulcerated 
breasts ; also in the use of arsenical solutions to the sore 
heads of children. In some of these instances, absorbed 
arsenic has been detected, after death, in the viscera of the 



242 TOXICOLOGY. 

body. Arsenic has also proved fatal when injected into the 
rectum and vagina. 

In all the above cases of the external application of 
this poison, its usual constitutional effects were produced, 
such as burning and constriction of the throat, thirst, vomit- 
ing and purging, great depression, and the various nervous 
disturbances above described. 

Fatal dose. — Tzvo grains maybe considered the minimum 
fatal dose for an adult, but smaller quantities have pro- 
duced alarming symptoms. On the other hand, recoveries 
have often occurred after very large doses — one to two 
ounces — have been swallowed. 

Fatal period. — The great majority of deaths occur within 
twenty-four hours, and of these the most within eight or ten 
hours. The shortest period is recorded by Dr. Taylor, of. a 
youth, aged seventeen years, who died in tzventy minutes 
from the effects of a large dose accidentally swallowed; the 
symptoms were of a tetanic character. Other cases are re- 
ported where death occurred in two or three hours. On the 
other hand, life may be prolonged for weeks , months or even 
years, the patient suffering greatly during the whole interval. 

Arsenic is not a ctimiilative poison ; it is temporarily de- 
posited in the liver and other organs of the body after ab- 
sorption, but it is rapidly eliminated from the system by the 
urine, bile and other secretions. Should the person sur- 
vive for two or three weeks, no trace of the poison may be 
found after his death, in consequence of its total elimination 
during the interim. The exact period at which arsenic is 
completely eliminated from the human system is not fixed, 
but the analyst need hardly expect to discover it after sixteen 
days, although it has been detected in the urine of a man 
twenty-one days after swallowing a large dose, and who 
subsequently recovered. 



ARSKNIC POST-MORTEM APPEARANCES. 243 

The rapidity with which it is absorbed and deposited in 
the tissues is very great. Dr. Taylor (^Oii Poisons, p. 46) 
found it in the liver four hours after it had been swallowed. 
He believes that the liver acquires its maximum of absorbed 
arsenic (about two grains) in fifteen hours, after which the 
quantity gradually diminishes. 

The question of the elimination of arsenic from the human 
system may have an important medico-legal bearing, as 
where a person who has been taking small doses of arsenic, 
medicinally, for a length of time, should suddenly die from 
gastro-enteritis, and a post-mortem examination should 
reveal the presence oi absorbed ?iX?>^mc in the organs. Here 
both the symptoms and the chemical analysis would 
strongly confirm the suspicion of arsenical poisoning, unless 
the fact of the medicinal administration of the drug could be 
satisfactorily established. 

Arsenic is known to be deposited in all the tissues of the 
body, including the bones ; but not in the hair. 

Post-mortem appearances. — The most decided evidences of 
the irritant character of the poison are exhibited by the 
stomach, the mucous lining of which is usually highly 
inflamed, sometimes presenting a uniform, deep red color, 
at others, showing patches of diffused dark redness. Arsenic 
seems to have a specific effect on the stomach, no matter by 
what avenue it is introduced into the system. Occasionally, 
the lining- membrane is thickened and corrugated ; again, it 
is softened, and readily separated. When the poison has 
been taken in substance, it is not unusual to find patches 
several inches in extent, consisting of tough, yellowish- 
white bases of arsenious acid, mixed with lymph and mucus, 
firmly adherent to the membrane, and forming so many foci 
of intense inflammation. White spots of arsenic are often 
found between the rugae, and when a long interval has 



244 - TOXICOLOGY. 

occurred before the examination, yellow stains may be 
found, as the result of a decomposition into the yellow 
sulphide. 

Ulceration of the stomach is rare ; but we have witnessed 
it in two instances, one quite recently, where death occurred 
in eight hours after swallowing the poison ; in the other 
case the examination was not made until four months after 
death ; here the ulcer was a quarter of an inch in diameter, 
and was surrounded by a deep zone of dark, effused blood, 
and had penetrated down to the peritoneal coat of the 
stomach. Perforation is still more rare. 

The upper portion of the small intestine is very apt to be 
involved in the inflammation ; also the caecum and rectum. 
Other organs, as the lungs, brain and bladder, are occasion- 
ally found congested ; but these offer no diagnostic points. 
The most remarkable fact connected with the post-mortem 
appearances is the occasional absence of all signs of inflam- 
mation, even in cases where there had been violent 
inflammatory symptoms before death. 

An important circumstance is the antiseptic power of 
arsenic, which accounts for the remarkable preservation of 
the body for many months after death, whereby the detec- 
tion of the poison is possible for along period after burial — 
in one case, fourteen years after death. Of course, after such 
an interval, most of the body would be decomposed, but 
still enough remains for the purpose of identification. In 
such cases there is generally noticed an absence of the usual 
cadaveric odor, and also the presence of numerous yellow 
patches over the abdominal viscera, due to the production 
of the yellow sulphide, by the action of sulphuretted hy- 
drogen on the arsenious acid. 

It should, however, be stated that arsenic does not uni- 
formly exert this preservative power on a dead body; in fact. 



ARSENIC CHEMICAL ANALYSIS. 245 

in some cases it would seem that putrefaction has advanced 
with increased rapidity. These instances, however, are ex- 
ceptional; but they should put the expert on his guard 
against too positive an assertion as to the presence of ar- 
senic when a body exhibits an unusual degree of preserva- 
tion, since this may be due to other causes (yid. a7ite p. 53). 

Treatment. — If vomiting is not active, a quick emetic (sul- 
phate of zinc and ipecac) should be administered, or a draught 
of mustard water; the stomach pump may be employed, if 
on hand; warm diluent drinks are useful ; after this, the free 
use of hydrated sesquioxide of iron. This can be prepared 
extemporaneously by diluting the tincture of the chloride 
and adding ammonia in excess, and washing the precipitated 
iron. This antidote must be taken in large doses, frequently 
repeated. Afterwards, a dose of castor oil should be given. 

There are numerous attestations to the value of this anti- 
dote ; it acts by converting the poison into the insoluble 
arsenate of iron. The freshly precipitated hydrate of magne- 
sia is also recommended as an antidote. 

Chemical Analysis. — I. In the solid state, (i) a small 
quantity of the white powder placed on platinum foil and 
heated is entirely dissipated in white inodorous fumes; (2) 
slowly heated in a narrow glass tube, it sublimes, forming a 
white ring of octahedral crystals on the cool portion of the 
tube, visible by a good magnifier. Calomel and corrosive 
sublimate will each form white rings under similar condi- 
tions; the arsenical deposit is distinguished from these (a) 
by the octahedral crystals ; (8) by the action of liquor 
potassae, which dissolves it without color, while it gives a 
black color to calomel and a yellowish-red to corrosive sub- 
limate ; (3) moistened with sulphide of ammonium, and 
evaporating, produces the yellow sulphide ; (4) put into a 
reduction tube along with some reducing agent, as charcoal, 



246 TOXICOLOGY. 

black flux, or dried ferrocyanide of potassium, and heated 
by the flame of a spirit lamp, it is reduced, and the metal 
is volatilized in the form of a brilliant steel-gray ring or 
mirror. 

In order to effect the sublimation successfully, certain pre- 
cautions are necessary. The reduction tube should be small 
— about the eighth of an Inch in diameter, and three inches 
long ; it should be perfectly clean and free from moisture. 
The reducing agent should be perfectly dry, and thoroughly 
mixed with the arsenious acid, in the proportion of three or 
four to one of the latter. After it is introduced into the 
tube, this should be wiped out with a wad of cotton or a roll 
of filtering paper. The tube should first be gently warmed 
just above the contents, and then fully heated in the flame. 
This precaution insures a better formed metallic ring. 

For the sublimation simply, the above process is to be 
pursued, with the omission of the reducing agent. 

The obtaining the metallic ring or mirror, by the reducing 
process, may be regarded as positive proof of the presence 
of arsenic ; but in a medico-legal case this should be con- 
firmed by further proofs: (i) the arsenic mirror is wholly 
soluble in hypochlorite of sodium; (2) it is soluble in hot nitric 
acid, and the solution, on evaporation, leaves a brick-red 
deposit when touched with nitrate of silver solution, due to 
the formation of arsenate of silver ; (3) if the closed end of 
the tube be broken off, and heat applied to the sublimate, it 
will readily volatilize, and, combining with the oxygen of 
the air, will condense on the upper portion of the tube, in a 
white ring of arsenious acid ; (4) this latter may be dissolved 
in a few drops of warm water, and subjected to the liquid 
tests. 

II. The liquid tests. — These are the ammonio-sulphate of 
copper and the ammonio-nitrate of silver. They should be 



ARSENIC CHEMICAL ANALYSIS. 247 

prepared only when required for use. The former is made 
by the cautious addition of aqua ammonise to a somewhat 
dilute solution of sulphate of copper, until the precipitated 
oxide is barely redissolved. When this reagent is added to 
a solution of arsenious acid, it throws down a ligJit green 
arsenite of copper (Scheele's green). This precipitate is 
soluble in ammonia, and in free acids. If the arsenic is in 
very minute quantities, the characteristic color does not 
appear immediately. 

The silver test is prepared by adding aqua ammonise to a 
strong solution of nitrate of silver until the precipitated 
oxide is barely redissolved. When this is added to the 
arsenical solution, a canary-yellow precipitate occurs (King's 
yellow), arsenite of silver, which, like the former, is freely 
soluble in ammonia and the acids. 

These liquid tests are available only in perfectly pnre 
solutions of arsenious acid; they are inadmissible in the 
presence of organic matter, e. g., the contents of a stomach, 
since various organic substances will produce similar colors 
with both copper and silver. They may, however, be satis- 
factorily confirmed (i) by heating either of the dried pre- 
cipitates (arsenite of copper or silver), either alone, or with a 
reducing agent, in a reduction-tube ; the former experiment 
will yield a sublimate of octahedral crystals, the latter the 
metallic mirror. (2) If the blue ammoniacal solution of 
the arsenic is poured over a crystal of nitrate of silver, a 
film of yellow arsenite of silver is immediately formed 
around it. 

III. The sulphuretted hydrogen test. — This consists in 
passing washed sulphuretted hydrogen gas through the 
solution of arsenious acid, slightly acidified by hydrochloric 
acid ; a clear, yelloiv precipitate falls — tersulphide of arsenic 
(orpiment), which is soluble in the alkalies, and insoluble in 



248 TOXICOLOGY. 

acids. In very dilute solutions, the precipitate does not 
separate until the excess of the gas is driven off by heat. 

Fallacies. — Cadmium, tin and sclcniiim yield somewhat 
similar precipitates with sulphuretted hydrogen. Practically, 
the only one that need be considered is cadmium, which, 
however, is easily distinguished from arsenic, as follows : 
(i) the arsenic sulphide is soluble in ammonia and insoluble 
in the acids ; with cadmium sulphide it is precisely the 
reverse ; (2) when dried and sublimed with a reducing 
agent, the arsenic sulphide yields a metallic ring; the 
cadmium, a brown oxide. 

In a poison case, the sulphide of arsenic should alwa3^s 
be proven by (i) obtaining the metallic ring by subliming it 
with a reducing agent; (2) by boiling the sulphide in hydro- 
chloric acid, along with a piece of bright copper foil ; a steel- 
gray deposit shows the presence of arsenic. 

IV. Marsh s Test. — The principle here involved is, that 
when arsenic comes in contact with nascent hydrogen, it 
combines with it to form arseniureted hydrogen, a gas which 
possesses peculiar properties, by means of which the arsenic 
may be recognized with great certainty. Practically, the 
simplest and best mode of performing the experiment is to 
add to the materials for generating hydrogen (zinc, water 
and sulphuric acid), in a wide-mouth flask, the suspected ar- 
senical solution. The cork fitted to the mouth of the flask 
should have two perforations, through one of which a per- 
pendicular glass tube passes down below the surface of the 
liquid contents ; through the other aperture a tube bent at 
right angles is inserted, out of which the generated gas 
issues. A drying tube (containing fragments of fused 
chloride of calcium, or of pumice stone moistened with sul- 
phuric acid) is fastened by one end to the exit tube, and by 
the other extremity to a horizontal tube of hard German 



ARSENIC marsh's TEST. 249 

glass, about a foot long, which may be turned up at the 
farthest end, and made to terminate in a small point, for 
burning the gas in a jet, as it escapes. 

In performing this experiment certain precautions are 
necessary. In the first place, the absolute purity of the 
zinc and sulphuric acid must be secured, since both of them 
are liable to be contaminated with arsenic. Secondly, cau- 
tion should be exercised to have the atmospheric air com- 
pletely expelled from the apparatus before lighting the jet, 
otherwise the mixture of hydrogen and air will produce a 
violent explosion. The evolution of the hydrogen should 
be rather slow and gradual. After waiting the proper time, 
the jet may be lighted ; it will burn, if pure, with a scarcely 
perceptible flame. The purity of the materials may now be 
tested by applying the flame of a large spirit lamp, or a 
Bunsen burner, to the horizontal glass tube until it is red 
hot; if no stain or deposit occurs just beyond the heated 
spot, the absence of arsenic is certain ; or, if no deposit 
forms on a piece of white porcelain held over the burning 
jet, the same conclusion may be held. 

A small quantity of the suspected solution is now to be 
introduced through the upright tube; its decomposition 
immediately commences, freeing the arsenmreted hydrogeji, 
which yields the following characteristic results : — 

(i) The ignited jet. — As soon as the arsenic combines 
with the hydrogen, an immediate change occurs in the 
appearance of the flame, which increases in size and acquires 
a faint, bluish color, and unless the arsenic be in minute 
quantity, it evolves white fumes, and gives out an alliaceous 
odor. If these fumes are received into a short, wide glass 
tube, they will condense into a white powder, sometimes 
crystalline, and may be rdentified as arsenious acid. 

If the jet be made to impinge on a piece of glass or 

12 



250 TOXICOLOGY. 

white porcelain, held horizontally, and just within the flame, 
a deposit of pure metallic arsenic, of a brilliant steel-gray or 
brownish-gray color occurs, which may be multiplied to 
any extent by changing the position of the porcelain. In 
order to procure the finest deposits, the flame should be 
steady and not too large. Although these spots m.ay vary 
somewhat in color, they are always brilliant and never 
sooty. 

These deposits may be identified (i) by their immediate 
solubility in hypochlorite of sodium : stains of antimony, 
which they most resemble, are not thus affected. (2) When 
touched with a drop of sulpJiide of ammonium, they do not 
immediately disappear ; antimony stains are instantly dis- 
solved. (3) Both metals dissolve in hot nitric acid, and on 
evaporation yield white residues ; if now touched with a 
drop of strong solution of nitrate of silver, the arsenic spot 
assumes a brick-red color, while the antimonial stain remains 
unaffected. 

(2) Decomposition of the gas by heat. — On placing the 
flame of a large spirit lamp, or a Bunsen burner, immediately 
below the horizontal tube (which should previously be con- 
tracted after heating it in several places), when it becomes 
nearly red hot, a deposit of metallic arsenic begins to form 
just in advance of the flame, which should be held a little 
behind one of the contracted spaces ; the deposit continues 
to increase until it may completely occupy the whole of the 
narrow space, and even advance beyond it. This constitutes 
the arsenical mirror. It may have the steel-gray, brilliant 
appearance already described, or even a coppery hue, and it 
is highly characteristic of the presence of arsenic. Several 
such mirrors may thus be obtained, by moving the flame to 
different parts of the horizontal tube, provided there is a 
sufficient amount of the poison to operate upon. The tube 



ARSENIC REINSCH's TEST. 251 

may afterwards be filed, so as to separate the mirrors, which 
may be retained for exhibition in court, as positive proof of 
the detection of the poison. 

This mode of experimenting yields even more delicate 
results than the jet; but unless the quantity of arsenic is 
extremely small, it will always be possible to obtain both re- 
sults by Marsh's process. 

One fallacy only might interfere with this experiment — 
the presence of antimony, which in contact with hydrogen 
yields a gas very similar to arseniureted hydrogen, and like 
the latter, is decomposed by heat, yielding a metallic deposit. 
They may be distinguished as follows : the antimony mirror 
is deposited just over the heated spot, and not in advance 
of it; it has usually a darker appearance than the arsenical 
mirror; the latter is more easily volatilized than the former, 
and condenses higher up in the tube, in octahedral crystals. 
The two deposits may also be tested by the different reagents 
mentioned above {vid. p. 246); also, by dry sidphuretted 
hydrogen, which produces with the arsenical gas a yellow 
deposit, and with the antimonial gas an orange-red. 

(3) Decomposition by nitrate of silver. — If the arseniureted 
hydrogen gas be passed through a solution of nitrate of 
silver, it immediately blackens it, from the precipitation of 
metallic silver, arsenious acid remaining in the solution. 
The filtered clean solution will contain, also, free nitric acid, 
and any excess of nitrate of silver. On neutralizing with 
ammonia, a yellow precipitate will fall — arsenite of silver 
{yid. p. 247). The analyst should not rely on the mere 
production of the black color, since other gases beside ar- 
seniureted hydrogen might cause this, but he should con- 
tinue the experiment as above described. 

V. Reinscks Test. — This consists in producing a deposit 
of metallic arsenic on bright copper foil. The suspected 



252 TOXICOLOGY. 

solution, acidulated with about one-sixth of its bulk of pure 
hydrochloric acid, is first brought to the boiling point, and 
a piece of bright copper foil is introduced, and the boiling 
continued. The presence of even a very minute quantity 
of arsenic is soon indicated by the tarnishing of the copper, 
which ultimately assumes a dark steel-gray, or even black, 
color. If the quantity of arsenic be large, the deposit is 
immediate, and very dark ; it may even break off in scales ; 
if the amount of the poison is very small, the stain upon the 
copper will be fainter, and merely of a violet, or bluish tint. 
Moreover, the deposit on the copper is affected by the de- 
gree of dilution ; hence, if the quantity of the water be large, 
it may require boiling for half an hour before a visible de- 
posit occurs. 

This reaction is very delicate and extremely satisfactory. 
One great advantage that it possesses over the other tests 
is, that it may be practiced in complex organic fluids ; hence, 
this test is usually employed in toxicological research, as 
the trial test. 

Certain precautions are, however, required in employing 
it. First, the purity of the hydrochloric acid must be 
insured; this is easily accomplished by first boiling some of 
the acid diluted with water, and then introducing a slip of 
the copper. If no stain appears upon the latter after fifteen 
minutes, we may be certain of the absence of arsenic or 
antimony from the acid. Secondly, the copper must be 
both bright and pure. Its brightness is effected by rubbing 
it with emory paper, and it maybe regarded d^s pure if, when 
boiled in the acid arsenical liquid, it is not dissolved, and 
does not impart a green color to the liquid. But, if deemed 
necessary to further test its purity, the process of Mr. Abel 
may be adopted : Add to pure hydrochloric acid, diluted 
with six parts of water, one or two drops of a weak solution 



ARSENIC REINSCH's TEST. 253 

of perchloride of iron ; boil the acid liquid, and introduce 
into it the copper, well polished ; if it contains arsenic it 
soon becomes tarnished ; if pure it remains bright. (Taylor, 
Mcd.Jurisp., 1883, p. 268.) 

In applying this test, it is best to use small pieces of 
copper successively, removing each fragment as it becomes 
coated. By this means the whole of the arsenic may be 
removed from the solution. We have ascertained, by actual 
experiment, that ojie grain of arsenious acid dissolved in 
the acid solution, and treated by Reinsch's process, will 
impart a distinct, dark, steel-gray coating to tJiree htindred 
square inches of copper surface. This method will, there- 
fore, serve for an approximative quantitative estimate of the 
poison. 

Another caution to be observed is not to remove the 
copper too soon from the liquid, in case no deposit occurs ; 
in doubtful cases, the boiling should be continued for half 
an hour. But, on the other hand, if the copper be kept in 
for an hour or longer, it may acquire a dark film, independ- 
ently of any arsenic. 

Fallacies. — Other metals beside arsenic will impart a dark 
coating to copper by Reinsch's process, such as antimony, 
mercury, silver, bismuth, tin, gold, platinum and palladium, 
and likewise organic matter^ especially if it contain sulphur. 
Hence, in the application of this test, the mere production 
of a dark deposit on the surface of the copper is not 
sufficient to establish the presence of arsenic, but further 
corroborative proof is required. This is afforded by wash- 
ing a fragment or two of the coated copper, and then 
thoroughly drying them between the folds of filtering paper, 
(avoiding touching with soiled fingers), and rolling them up 
into small coils, and then introducing one or more of them 
into a small, clean reduction-tube and applying the heat of 



254 TOXICOLOGY. 

a spirit lamp. The arsenic will volatilize and condense in 
the cool part of the tube, in a white ring of octahedral crys- 
tals. The only other metals which could volatilize under 
such circumstances are antimony and mercury ; but the sub- 
limate from antimony is either amorphous, or else in fine, 
acicular crystals, while the mercurial deposit consists of 
fine, spherical globules of the metal, easily recognized by a 
magnifier. 

The attention of the toxicologist should especially be 
directed to the fact, that if copper be boiled for some time 
in an acid solution of complex organic matters, it will be- 
come coated with a decided dark stain, and will, moreover, 
yield, when heated in a reduction-tube, an amorphous 
sublimate, which may even sometimes show acicular crys- 
tals, consisting apparently of a compound of copper. VVe 
have repeatedly verified this by our own observations. 
Hence, it follows that, for the complete corroboration of 
Reinsch's test for arsenic, in a medico-legal case, we can 
admit nothing short of tlie production of tlie octahedral crys- 
tals, and their subsequent identification. 

It must also be remembered that the presence of certain 
substances in the arsenical solution may prevent the deposit 
of this metal upon the copper, viz., a chlorate, binoxide of 
manganese, or other bodies that decompose hydrochloric 
acid and evolve chlorine ; likewise strong nitric acid. Con- 
sequently, Reinsch's test is ^^^^^ applicable to the clear solu- 
tion obtained by boiling the viscera in hydrochloric acid 
and chlorate of potassium {vid. post) 

VI. Bloxam's method. — The principle here involved is the 
same as that in Marsh's process — the action of arsenic on 
nascent hydrogen ; only, electrolysis is employed to decom- 
pose the water instead of zinc. It is a delicate and satis- 
factory method, but it should be remembered that the 



ARSENIC TOXICOLOGICAL EXAMINATION. 255 

arsenic must always be present in the form of arsenious 
acid. 

There are some other reagents of inferior importance for 
the recognition of arsenic, as lime water, iodide of potassium^ 
bichromate of potassium, etc., but these require no further 
notice. 

Toxicological examination. — The analyst should always 
first search for particles of solid arsenious acid in the 
stomach and the vomited matter, and carefully remove 
these for examination. Organic mixtures should be diluted, 
if necessary, with distilled water, and acidified with about 
one-sixth part of hydrochloric acid and boiled gently for 
about fifteen minutes ; when cooled the mixture should be 
strained and concentrated by evaporation over a water bath. 
A port-ion may now be subjected to a trial test by Reinsch's 
process ; if no deposit takes place after boiling for half an 
hour, it is safe to conclude that no arsenic is present. But 
if deemed advisable, another portion of the filtrate may be 
subjected to Marsh's process, and to the action of sulphur- 
etted hydrogen. 

The stomacJi and contents. — This organ should first be 
carefully examined as to its pathological condition {vid. 
ante, p. 6i), and also for the presence of solid particles of 
the poison. It should then be cut up into small fragments, 
with scissors known to be perfectly clean, and together with 
its contents, placed in a clean, porcelain evaporating dish, 
distilled water added in sufficient quantity, together with 
about one-sixth the bulk of pure hydrochloric acid, and the 
whole boiled gently for about an hour, when most of the 
solid portions will have become disintegrated. After cool- 
ing, the mixture is thrown upon a muslin strainer, and the 
solid matters washed several times with pure warm water 
and squeezed. The strainer and contents should be pre- 



256 TOXICOLOGY. 

served for subsequent examination, if required. The filtrate 
should be concentrated by evaporation over a water bath, 
and then filtered through paper. 

Reinsch's process may now be applied as a trial test to a 
portion of the liquid. If no result is afforded after a suffi- 
cient boiling, other portions may be tried by Marsh's pro- 
cess, and by sulphuretted hydrogen; and if these give nega- 
tive results, the absence of arsenic may be regarded as es- 
tablished. 

But if the presence of the poison is revealed by the trial 
test, a given portion of the liquid may be completely ex- 
hausted by Reinsch's process {vid. ante, ^. 251), and the 
balance treated with sulphuretted hydrogen for several hours, 
until all the arsenic is precipitated. This process is facilitated 
by gently warming the liquid. The resulting precipitate 
will have a dirty yellowish color — not the bright yellow 
where the arsenic is pure, — and will contain both organic 
matter and reduced sulphur, in greater or less amounts. 

The m.ere production of such a precipitate is not sufificient, 
of itself, to establish the presence of arsenic, since it is known 
that in an acid, complex, organic solution, associated with 
coloring matter, sulphuretted hydrogen will throw down a 
precipitate very much resembling either an impure arsenical 
or antimonial sulphide, but consisting only of organic ^natter 
and free sulphur ; hence, a further examination is required 
to verify this suspected sulphide. 

The precipitate then should be washed carefully on a fil- 
ter, and digested with pure aqua ammoniae, which will dis- 
solve out all the sulphide of arsenic, together with some 
organic matter. The solution is filtered and carefully 
evaporated to dryness. If much arsenic is present it will 
have a decided yellow color. When perfectly dried it 
should be verified by the methods described above (p. 248). 



ARSENIC TOXICOLOGICAL EXAMINATION. 257 

If, however, only a minute, quantity of arsenic be present in 
the dried residue, which will have a brown color, it must be 
purified as follows : it is placed in a porcelain capsule, and 
a little concentrated nitric acid is added, and the mixture 
evaporated to dryness over a water bath, the acid being re- 
peated until the moist residue has a yellow color. It is next 
moistened with a few drops of solution of caustic soda, to- 
gether with a little pure carbonate and nitrate of sodium well 
stirred, and cautiously evaporated to dryness. The heat is 
now gradually increased until the mass becomes colorless, 
when the organic matter may be considered completely de- 
stroyed. The cooled mass consists of a mixture of the ar- 
senate of sodium with nitrate and nitrite of sodium. It should 
be dissolved in warm water, and after filtration, should be 
acidulated with pure sulphuric acid and evaporated till dense 
white fumes appear. By this treatment the residue is re- 
duced to a mixture of the arsenate and sulphate of sodium. 
A portion of this solution may now be tested in a Marsh's 
apparatus ; another given portion, by sulphuretted hydrogen, 
for quantitative determination, the arsenic acid being first 
reduced to arsenlous acid by sulphurous acid, or sulphite of 
sodium. 

Separation of absorbed arsenic from the tissues. — It Is 
always desirable. If not indispensable. In a poison case, to 
prove the presence of absorbed arsenic in the different 
viscera, as the liver, kidneys, spleen, etc.. Inasmuch as Its 
detection in the organs Is positive proof that the poison had 
been actually taken during life, provided always that post- 
mortem imbibition can be excluded {ind. ante, p. 193). Be- 
sides, It may happen that, if the quantity swallowed has been 
only just sufficient to have caused death, the whole of it 
may have disappeared from the stomach by absorption, and 
can only be discovered in the organs. The brain should 
12* 



258 TOXICOLOGY. 

always be examined ; in the only case where this organ was 
submitted to an examination by us, arsenic was readily 
discovered by the usual tests. 

Several methods are described for this sort of research, 
all having reference to one common end — the destruction of 
organic matters. In several instances, we have succeeded 
perfectly in detecting arsenic in the organs by simply boil- 
ing the finely-divided tissue in water and hydrochloric acid, 
and applying Reinsch's test. 

Method of Freseniits and Babo. — The solid matters (as 
about one-fourth of the liver) should be finely divided, 
pressed in a mortar, and pure water added to bring it to the 
consistence of thin gruel. The whole should then be 
digested in a porcelain dish over a water bath, with pure 
hydrochloric acid about equal in weight to the dry material. 
Small quantities of powdered chlorate of potassium are 
from time to time added to the hot liquid, when efferves- 
cence will occur, with escape of chlorine gas. In a short 
time the solid matters will disappear, and the liquid will 
acquire a clear, yellow color. The heat should be con- 
tinued until all odor of chlorine has disappeared. When 
the liquid has cooled, it should be properly strained. Any 
arsenic present would exist in the form of ai'senic acid. 

A portion of this liquid may be tested in a Marsh's appa- 
ratus {vid. p. 248). But for the other tests it is necessary 
that the arsenic acid should be reduced to the lower oxide — 
arsenious acid. This is effected by adding sulphite of sodium 
to the solution, and heating it until all odor of sulphurous 
acid has disappeared. It is now allowed to stand for several 
hours, and any deposit removed by filtration. The resulting 
solution may be examined by sulphuretted hydrogen, but 
not by Reinsch's process, for the reason above given {yid. 
p. 254). 



ARSENIC EXAMINATION OF THE URINE. 259 

MetJiod of Danger and Flandin — The organs, properly 
divided, are introduced into a glass retort, together with 
strong sulphuric acid, and heated on a sand-bath, until the 
whole is thoroughly carbonized, and dried. After cooling, 
the mass is removed and powdered. The powder is mois- 
tened in a porcelain capsule, with one-tenth of its weight of 
pure nitric acid, and heated on a water-bath for half an hour. 
This converts the arsenic into arsenic acid. Warm distilled 
water is now added, and the matters filtered through paper. 
The filtrate is colorless, if pure ; if colored, it must be 
evaporated to dryness, treated again with nitric acid and 
water, and filtered the second time. The acid liquid must 
next be evaporated to dryness, to get rid of the nitrous 
vapors. It should now be mixed with a sufficient quantity 
of water, when it will be fit for testing, as above described. 

The distillation process. — The tissue should first be 
thoroughly dried over a water-bath, and then mixed with 
about its own weight of pure hydrochloric acid, and dis- 
tilled in a retort over a sand-bath, almost to dryness, the 
distillate being received into a small quantity of water 
properly refrigerated. By this process the arsenic is sepa- 
rated as a terchloride. It possesses the advantage of imme- 
diately separating the arsenic, in a tolerably pure state, from 
the tissues. The distillate may be subjected to all the usual 
tests. ' 

The urine can be examined by Reinsch's test, by first 
concentrating by evaporation ; or it may be evaporated to 
dryness, and then treated with hydrochloric acid and chlo- 
rate of potassium, and examined in the usual way. 

Arsenic is not a normal constituent of the human body. 
Neither is it ever found in the soil of cemeteries in a soluble 
state ; consequently, there need be no apprehension of a 



260 TOXICOLOGY. 

dead body ever imbibing this poison, after burial, from the 
surrounding earth. 

Arsenic is estimated quantitatively, as 2^ sulphide ; lOO 
grains of pure dried sulphide represent 80.48 of arsenious 
acid. 

OTHER PREPARATIONS OF ARSENIC. 

Arsenite of Potassium — Fowler's Solution. — This prepara- 
tion, much used in medicine, is made by boiling arsenious 
acid with carbonate of potassium and tincture of lavender. 
It contains /^?/r grains of arsenic to the fluid ounce. 

Arsenic Acid. — A powerful poison, but not employed as 
such. It is tested as arsenious acid; with sulphuretted hy- 
drogen it yields a yellow precipitate after a considerable 
time. Its most delicate test is nitrate of silver, which yields 
a brownish-red precipitate — arsenate of silver. 

The N. Y. Medico-legal Journal, March, 1884, contains an 
interesting account, by Prof. B. Silliman, of the death of a 
boy, aged between three and four years, from arse?tate of 
sodium, a poisonous preparation sold in New York, under 
the name of /^.y/ /(9/i-(?;/, for destroying potato bugs. The 
most singular circumstance connected with the case is the 
entire absence of all the usual symptoms of arsenic pois- 
oning, such as pain, vomiting and purging, etc.; but, on the 
contrary, those of a powerful narcotic, like belladonna, 
or stramonium. There were profound stupor, dilatation of 
the pupils, a rapid pulse, and hurried respiration. After 
partial recovery, a relapse took place, the child dying, ap- 
parently, from asphyxia, about nine hours after swallowing 
the poison. 

Arsenite of Copper — Scheele's Green. — A fine green powder, 
containing one part of arsenious acid to two of oxide of 
copper. By sublimation in a reduction-tube, it yields crys- 



ARSENIC SULPHIDES. 261 

tals of arsenious acid. It is soluble in ammonia and in 
nitric acid. 

Aceto-arsenite of Copper — Schweinfurt, or Brunswick 
Green — Vienna, or Emerald Green — Paris Green. — A pig- 
ment very much used for staining wall paper, bon-bon 
paper, toys, etc. Also, to give a fine green color to articles 
of dress, artificial flowers, and millinery. It is composed of 
six parts of arsenious acid, two of oxide of copper, and one 
of acetic acid. It is readily identified by heating it in a test 
tube, when it gives off fumes of acetic acid, deposits crystals 
of arsenious acid, and leaves a residue of oxide of copper. 

Paper, and other articles colored with this pigment, may 
be easily tested by dipping them into a weak solution of 
ammonia, when they will be speedily bleached, and the 
solution will become blue. If now a crystal of nitrate of 
silver be placed in the latter, a film of yellow is immediately 
formed around it — arsenite of silver. A drop of aqua 
ammoniae applied to paper colored by this pigment imme- 
diately turns it blue. 

Chronic arsenical poisoning is a frequent result of living 
in rooms whose walls are covered with this green paper ; 
the fine powder or dust detached from the walls is inhaled 
into the lungs, and produces the symptoms above described. 

Sulphides. — There are two native sulphides, the yellow 
(tersulphide) or orpiment, and the red (pentasulphide) or 
realgar. The yellow sulphide is sometimes taken as a 
poison. They are both soluble in ammonia, and when 
mixed with a reducing agent and sublimed, they yield 
metallic mirrors (ind. ante, p. 248). 



262 TOXICOLOGY. 



CHAPTER XVIII. 

POISONING BY ANTIMONY— (TARTAR EMETIC). 

PROPERTIES OF TARTAR EMETIC — SYMPTOMS — FATAL DOSE — POST- 
MORTEM APPEARANCES — SLOW POISONING — CHEMICAL ANALYSIS — 
TOXICOLOGICAL EXAMINATION. 

The only preparation of antimony of medico-legal im- 
portance is tartar emetic. Occasionally, the chloride is a 
cause of poisoning. 

Tartar Emetic (tartarized antimony ; stibiated tartar, 
tartrate of antimony and potassium). This is a double salt, 
consisting of tartaric acid in combination with teroxide of 
antimony and protoxide of potassium. When pure, it 
occurs in large, colorless, octahedral crystals ; also as a white 
powder. The commercial salt sometimes contains traces of 
arsenic. Heated in a reduction-tube, it readily blackens, 
from the decomposition of the organic acid, and is reduced 
to a mixture of carbon and metallic antimony. Heated on 
charcoal, before the blowpipe, it is also reduced, yielding 
globules of the metal, along with a white incrustation of the 
oxide. 

It is soluble in three parts of boiling, and fifteen of cold 
water ; its solution soon undergoes decomposition. It is 
insoluble in alcohol. A hot solution on evaporation yields 
tetrahedral crystals. 

The taste is nauseous, metallic and acrid, or, according to 
some, slightly sweetish and styptic. 

Symptoms. — A harsh, metallic taste is perceived on swal- 
lowing, soon followed by nausea, retching, violent and 
incessant vomiting, great thirst, constriction of the throat. 



ANTIMONY FATAL PERIOD. 263 

burning pain in the stomach and abdomen, profuse purging 
of a watery character ; sometimes blood is found in the dis- 
charges both from the stomach and bowels ; severe cramps 
in the extremities, a very feeble, rapid pulse, profuse per- 
spiration, extreme prostration, with a disposition to syncope. 
The urine is generally increased in quantity, but is voided 
with pain ; at times there may be delirium and convulsions 
preceding death. In exceptional cases, there is an absence 
of vomiting and purging, the symptoms being those of ex- 
treme collapse, with a cold, clammy sweat, feeble respiration, 
irregular pulse, delirium, unconsciousness and tetanic con- 
vulsions. (Husemann, Toxicol, p. 853.) 

An occasional symptom, if the patient survives three or 
four days, is a pustular eruption over the body, similar to 
that produced by the external application of tartar emetic. 

In some instances it appears to exert a slightly corrosive 
impression, causing aphthous ulceration of the tongue and 
inside of the mouth. 

While acting as an irritant to the gastro-enteric mucous 
membrane, it undoubtedly exerts a depressant effect upon 
the heart. 

Fatal dose. — This has not been precisely determined. A 
good deal depends on the idiosyncrasy. In some cases, 
two or three grains have produced alarming and even fatal 
effects, whilst, in others, enormous doses, up to an ounce, 
have failed to destroy life. Large doses, by exciting speedy 
vomiting, generally relieve themselves. Probably, twenty 
to forty grains may be regarded as the usual minimum 
fatal dose for an adult. 

Fatal period. — From an hour, up to several days. In an 
exceptional case related by Deutsch, a woman took by mis- 
take a scruple of tartar emetic, and died one year afterwards, 
from the irritant effects on the alimentary canal. 



261 TOXICOLOGY. 

Post-mortem appearances. — The irritant effects of this 
poison are displayed upon the hning membrane of the 
stomach and bowels, which is deeply reddened, softened and 
covered with a blackish, thick and viscid secretion, some- 
times streaked with blood. The throat, oesophagus, stomach 
and bowels also exhibit aphthous-looking spots, or excoria- 
tions, and occasionally true pustules may be seen scattered 
throughout the intestinal tract. 

The liver is generally enlarged and softened, and seems 
to have undergone a fatty degeneration. It is stated that 
the natives of Brunswick feed their geese upon the oxide of 
antimony, for the purpose of fattening them by increasing 
the size of their livers. 

The lungs are often deeply congested, sometimes exhibit- 
ing a true apoplexy. The mucous lining of the windpipe 
and bronchi is uniformly reddened. The brain is generally 
congested, both in its membranes and substance, the latter 
presenting, when cut, numerous bloody points. The ven- 
tricles occasionally contain an excess of serum, and there 
may also be some sub-meningeal serous effusion. The 
heart exhibits nothing abnormal. 

Treatment. — Vomiting should be assisted by warm muci- 
laginous drinks, or the stomach-pump may be employed. 
The proper antidote is tannin, in the form of some astringent 
vegetable infusion, such as green tea, or galls. Afterward, 
opium and stimulants will be necessary. 

Chronic poisoning. — This method of poisoning is believed 
to be more frequent than formerly. The symptoms are a 
distressing nausea, with occasional vomiting, diarrhoea, with 
pasty stools, loss of appetite, emaciation, slimy tongue, feeble 
action of the heart, difficult breathing, a pale and anxious 
countenance, faintings, with increased perspiration and 
urination. 



ANTIMONY TESTS. 265 

External application. — When applied to the skin, tartar 
emetic occasions deeppustulation; it is also readily absorbed, 
especially from abraded surfaces, and produces all its con- 
stitutional effects the same as if swallowed, such as nausea, 
vomiting, debility, etc. Fatal effects have thus resulted, and 
the poison has been detected, after death, in the stomach, 
liver, kidneys, and other organs. 

Chemical analysis. — i. As a solid. — Touched with a drop 
of sulphide of ammonium, or a solution of sulphuretted 
hydrogen, it immediately acquires an orange-red color; this 
is characteristic of all the salts of antimony in their pure 
state. Heated in a reduction-tube, it blackens {vid. p. 262). 

2. As a liquid. — {a) A drop of a strofig solution, evapo- 
rated on glass, will exhibit the tetrahedral crystals ; a weak 
solution gives a mass of confused crystals. (^) Either of 
the mineral acids dropped into it produces a white precipi- 
tate, soluble in an excess of the acid ; this precipitate is also 
soluble in tartaric acid, (c) No precipitate by ferrocyanide 
of potassium. (^) Acidulated with hydrochloric acid, and 
boiled on bright copper foil, the latter acquires a violet- 
colored deposit of metallic antimony (Reinsch's test). 
{e) The above solution imparts a black stain to a strip of 
pure tin foil in the cold, whereby it is distinguished from 
arsenic. (/) Sulphuretted hydrogen, or sulphide of ammo- 
nium, throws down from a piire solution a characteristic 
orange-red precipitate of sulphide of antimony. This pre- 
cipitate is soluble in caustic alkalies, but scarcely so in 
ammonia ; insoluble in dilute hydrochloric acid, but if 
boiled in the concentrated acid, it is decomposed with the 
escape of sulphuretted hydrogen, and the formation of the 
terchloride of antimony. The resulting solution, if not too 
acid, when dropped into water immediately throws down a 
copious, white, flaky precipitate (the oxychloride, or powder 



266 TOXICOLOGY. 

of algaroth), which is quite characteristic. This may be 
identified as antimonial (i) by its solubility in tartaric acid; 
(2) by touching it with sulphide of ammonium, which im- 
parts to it an orange-red color. The white precipitate 
obtained by dropping the nitrate of bismuth into water is 
not soluble in tartaric acid, and is blackened by sulphide of 
ammonium. 

(^) The Galvanic test. — This is made by placing a few 
drops of the solution, acidified by hydrochloric acid, upon a 
platinum capsule, and touching the latter, through the liquid, 
with a strip of bright zinc ; metallic antimony Is deposited 
on the platinum at the point of contact, as a brownish or 
black film. The liquid should then be poured off, and the 
platinum washed In distilled water. A small quantity of 
sulphide of ammonium poured upon the stain speedily dis- 
solves It (If antimony) by the aid of heat, and on evaporation, 
an orange-red sulphide remains. A modification of this test 
may be advantageously applied for the detection of antimony 
in the organs iitid. post) 

(h) Marsh's test. — This is employed in the same manner 
as for arsenic (vid. ante, p. 248). If a solution of tartar 
emetic, or any of the soluble antimonial salts, be subjected 
to Marsh's test, anthnonetted hydrogen Is generated In pre- 
cisely the same manner as is arsenlureted hydrogen, under 
the same conditions. 

(i) If the gas is Inflamed at the jet, it burns with a bluish 
flame, evolving white fumes of teroxide of antimony, and If 
these fumes are received Into a short, wide test-tube, held 
just above the flame, the white deposit of the teroxide may 
be collected, which may be identified by sulphide of am- 
monium. If a piece of cold white porcelain be held hori- 
zontally just within the flame, the metal is deposited (as in 
the case of arsenic) in the form of a black, or nearly black. 



ANTIMONY marsh's TEST. 267 

spot, which is usually surrounded by a grayish ring. These 
deposits may be multiplied by simply changing the position 
of the porcelain. 

The only fallacy to which this test is liable is from arsenic, 
which, as has been shown, behaves in a precisely similar 
manner. But they can readily be distinguished from one 
another by a little attention. The antimonial deposit is, as 
a rule, blacker and less brilliant than the arsenical; but if 
the spots of antimony are extremely small — as when the 
quantity examined is minute — this distinction is not so ob- 
servable. Again, the antimony stains are more slowly dis- 
sipated by heat than the arsenical; the former immediately 
dissolve in a drop of sulphide of ammonium, leaving, on 
evaporation, an orange-red deposit; the latter (arsenical) are 
slowly affected by it, and leave, on evaporation, a yellozv 
residue. Furthermore, the arsenic deposit is immediately 
soluble in a solution of hypochlorite of sodium, which has 
little, or no effect upon the antimonial stain. Nitric acid 
will also serve to distinguish them: both are dissolved by 
it, but on evaporation to dryness, the arsenical residue 
gives to a solution of nitrate of silver a brick-red color 
(arsenate of silver), but the antimonial residue is not 
affected by it. 

(2) If heat be applied to the horizontal tube in Marsh's 
apparatus during the passage of the antimonetted hydrogen, 
decomposition takes place, as in the case of arsenic, but the 
deposition of the antimonial mirror occurs immediately over 
and around the heated portion, and not in advance of it. 
If the quantity operated upon is very small, the deposit may 
take place wholly within the point of heat. These metallic 
deposits exhibit the same chemical reactions as those pro- 
duced on porcelain by the ignited gas. 

(3) If the antimonetted hydrogen be passed into a solu- 



268 TOXICOLOGY. 

tion of nitrate of silver, the latter (as in the case of arsenic) 
becomes black ; the whole of the antimony is precipitated 
as antivionide of silver (with arsenic, the precipitate consists 
of metallic silver, the arsenious acid being kept in solution). 
This black precipitate should be collected on a filter, 
washed and boiled with tartaric acid, which dissolves out 
the antimony, and leaves the silver. On filtering the solu- 
tion, and treating it with sulphuretted hydrogen, the charac- 
teristic orange-red sulphide is precipitated. 

Toxicological examination. — In certain cases it might be 
desirable to separate the tartar emetic, as such, from the 
stomach ; this may sometimes be accomplished by dialysis. 
The exhibition of the poison in the exact state in which it 
had been swallozved, would always strongly impress a jury. 
But for all practical purposes, it is deemed sufficient if the 
analyst can detect the antimony. The process of dialysis 
may also be employed to separate tartar emetic from food 
and vomited matters, but not, of course, for detecting 
absorbed antimony in the tissues. 

The stomach, properly divided, and contents, should be 
acidulated with tartaric acid and gently heated, with 
sufficient distilled water, over a water bath, for about half 
an hour. When cold, the matters should be strained 
through muslin ; the solid portions are to be washed and 
pressed, and the whole of the liquid carefully evaporated to 
about one-half Trial tests may now be made on a portion 
of this liquid {a) by inserting a piece of pure tin foil in the 
cold; it will soon blacken if antimony is present; {p) acidu- 
late with hydrochloric acid and boil ; then place a piece of 
bright copper foil (Reinsch's test), it will speedily acquire a 
violet stain, {c) The remainder of the liquid, slightly 
warmed, should be treated with sulphuretted hydrogen gas 
for several hours ; a dirty, orange-red or brown precipitate 



ANTIMONY TOXICOLOGICAL EXAMINATION. 269 

will be thrown down, consisting of tersulphide of antimony, 
organic matter and reduced sulphur {vid. a^tte^ p. 256). 

The importance of identifying this precipitate cannot be 
over-estimated by the toxicologist. The mere production of 
a reddish-brown deposit under these circumstances is not 
sufficient to establish the presence of the alleged poison; 
what has been said upon this point under the head of Ar- 
senic applies with equal force to antimony. Neither will it 
suffice to proceed only one step farther, and dissolve the 
suspected sulphide in boiling hydrochloric acid, and throw 
the resulting solution into water, and obtain a white pre- 
cipitate therein, since all these results may ensue, as our 
experience can testify, from a similar treatment of the col- 
ored sulphur-organic deposits above alluded to, where 710 
antimony has been -present; for these also are, to a great 
extent, soluble in hot hydrochloric acid, and the resulting 
solution, if thrown into water, will occasion a white pre- 
cipitate. We do not wish to be understood as saying that 
these sulphur-organic precipitates possess all the characters 
of the trtie sulphide of antimony — especially such as would 
result from a pure solution, — but they do resemble in many 
respects the precipitate from an antimonial solution mixed 
with or gallic mattei^s. It is for this reason that we insist, in 
a poison case, on a very searching corroboration of this 
particular test. The analyst should proceed still another 
step, and subject the white precipitate to the action of tar- 
taric acid, and of sulphide of ammonium [vid. p. 266). 

It may properly be remarked here that in every medico- 
legal case of poisoning with antimony (as indeed with other 
metals), the actual obtaining of the metal should be rigor- 
ously insisted on, as the only absolute and unequivocal 
proof; and this, too, in quantities sufficient to admit of its 
positive identification by all the recognized tests. Nor should 



270 TOXICOLOGY. 

this be considered as a mere arbitrary or capricious rule. 
The highest toxicologlcal authorities, such as Orfila, Tardleu 
and Taylor, sanction it. Besides, the extraction of the 
metal is not difficult, e. g., by tin foil, by galvanism, by 
Marsh's and Relnsch's processes, and by the blowpipe. 

/;/ the 07'gans and tissues. — Most of the absorbed poison 
will be found in the liver and kidneys. A given portion of 
these organs, properly divided, should be boiled In water 
acidulated with about one-sixth of hydrochloric acid. After 
proper concentration, trial tests may be made with a strip of 
tin foil in the cold, and copper foil in the boiling solution. 
If any indications of antimony are given, Relnsch's process 
maybe carried out by subjecting a number of pieces of cop- 
per to the boiling acid liquid. These should be thoroughly 
washed, and dried between the folds of bibulous paper; then 
rolled up, and Introduced into glass reduction-tubes, and 
heated by the flame of a spirit lamp; a white sublimate will 
be deposited on the cool portion of the tube, as in the case of 
arsenic; but it is either amorphous, or else composed of very 
fine acicular crystals {Miller s Inorganic Chem. p. 602). 

The true nature of this antlmonial deposit is best shown, 
according to Watson, by boiling the coated copper in a 
dilute solution of caustic potassa, the metal being occasion- 
ally withdrawn from the liquid and exposed to the air to 
favor the oxidation of the antimony, when, after a time, the 
deposit will be wholly converted into antlmonate of potas- 
sium, which will be in solution. The copper strip should 
now be removed ; acidulate with hydrochloric acid, and 
pass sulphuretted hydrogen through the liquid, when the 
pentasulphide of antimony will be thrown down, of an 
orange-red color. The whole of the antimony may be thus 
removed by employing successive slips of copper, and sub- 
jecting them to the above treatment. 



ANTIMONY EXAMINATION OF THE URINE. 271 

The galvanic test may also be applied with great certainty, 
to detect the presence of antimony in the tissues. Prof. 
Taylor's plan is an excellent one: Coil a portion of pure 
zinc foil around a piece of clean platinum foil, and suspend 
them in the acid solution of the tissues, sufficiently dilute to 
prevent too violent an action on the zinc. The liquid should 
be warmed. Sooner or later, according to the quantity of 
antimony present, the platinum will be coated with an 
adhering black powder of metallic antimony. Wash the 
platinum foil, and digest it in strong nitric acid, which will 
dissolve off the antimony; remove the platinum, and evapo- 
rate to dryness. Re-dissolve the residue in hydrochloric 
acid ; dilute the solution, and treat with sulphuretted 
hydrogen, which will precipitate the pure sulphide ; or, the 
deposit on the platinum may be dissolved off by sulphide 
of ammonium {vid. p. 266). 

The absorbed antimony may also be extracted by means 
of chlorate of potassium and hydrochloric acid {vid. p. 258). 
But, in this case, in the subsequent application of sulphur- 
etted hydrogen, there is no occasion to employ sulphurous 
acid to effect a reduction to a lower oxide, as in the case of 
arsenic. 

It has been ascertained that antimony may be eliminated 
through the glands of the stomach, even when introduced 
into the system by some other avenue, e. g., by antimonetted 
hydrogen through the lungs. 

The uiHfie should always be examined in cases of sus- 
pected antimonial poisoning. This secretion is very soon 
affected by the salts of antimony, and it may contain traces 
of them for some time after their discontinuance. The 
urine should be evaporated nearly to dryness, when it may 
be examined either by Reinsch's test, by tin foil, by the 
galvanic test, by Marsh's process, by chlorate of potassium 



272 TOXICOLOGY. 

and hydrochloric acid, with sulphuretted hydrogen, and by 
carbonizing with sulphuric acid {vid. post., p. 259). 

Chloride of Antimony {Butter of Antimony). — A strong, 
corrosive poison, and one that has proved fatal in a number 
of instances. Its symptoms and post-mortem lesions re- 
semble those of the corrosive acids rather than those pro- 
duced by tartar emetic. When thrown into water, the oxy- 
chloride is generated, and falls as a copious, white, flaky 
precipitate. This is soluble in tartaric acid, and is instantly 
colored orange-red when touched with sulphide of ammo- 
nium. The clear liquid contains hydrochloric acid, as shown 
by nitrate of silver, which precipitates chloride of silver. 

Antimony is estimated quantitatively as a terstdphide. 
Every 100 grains of pure, dry tersulphide are equivalent to 
85.75 of the teroxide, or 202.85 parts of crystallized tartar 
emetic. 



POISONING BY MERCURY. 273 



CHAPTER XIX. 

POISONING BY MERCURY— (CORROSIVE SUBLIMATE). 

CORROSIVE SUBLIMATE. — PROPERTIES. — SYMPTOMS. — POST-MORTEM 
APPEARANCES. — FATAL DOSE. — ANTIDOTES. — CHEMICAL ANALYSIS. 
— TOXICOLOGICAL EXAMINATION. — SALIVATION. 

Mercury is not poisonous in the metallic state. Liquid 
mercury was formerly administered to relieve constipation. 
The vapor is poisonous when inhaled, and as this is given 
off from the metal, even at ordinary temperatures, it happens 
that artisans who work in mercurial ores, looking-glass platers, 
water gilders, barometer makers, etc., are very liable to be- 
come poisoned by the fumes. The symptoms of this sort 
of poisoning may come on gradually, or suddenly; they may 
or may not be accompanied with salivation. They are 
chiefly marked by the production of tremors of the limbs 
and paralysis, indicating the action of the metal on the nerve 
centres. The general condition thus induced is named 
mercurial tremors^ and shaking palsy. The upper extremities 
are usually first affected, and then, by degrees, all the mus- 
cles of the body. There is an unsteadiness in the arms and 
legs, so that the patient cannot grasp an object, nor walk 
firmly on the ground. In bad cases, he can neither speak, 
nor chew his food. If the disorder be not checked, it pro- 
ceeds to a fatal termination, attended with a loss of memory, 
insomnia and delirium. Another curious symptom, not 
generally recognized, but usually present, is a brittle state 
of the teeth, causing them to chip (Guys For en. Med?) 

The proper prophylactic treatment in this affection con- 
sists in cleanliness and good ventilation, together with the 
13 



274 TOXICOLOGY. 

free internal use of albumen, in the form of white of 
eggs. 

All the mercurial compounds are more or less poisonous, 
but the most important one, from a medico-legal point of 
view, is corrosive sublimate. 

Corrosive Sublimate — [Mercuric Chloride — Corrosive 
Chloride of Mercury). — Occurs either in heavy crystalline 
masses of prismatic crystals, or as a white powder. It has 
a powerful metallic, styptic, nauseous taste, and is soluble 
in about sixteen parts of cold, and three of boiling water. 
Alcohol and ether, also, freely dissolve it, and the latter has 
the power of abstracting it from its aqueous solution. 

Symptoms. — These usually come on immediately after 
taking the poison. A strong metallic, styptic taste is per- 
ceived, with a sense of heat, and choking in the throat. A 
fierce, burning pain is felt, extending from the mouth to the 
stomach ; nausea, retching and vomiting of stringy mucus, 
often tinged with blood ; pain in the abdomen, which usually 
is swollen and tender to the touch ; severe purging, some- 
times of bloody matters, accompanied with tenesmus, as in 
dysentery. The pulse is feeble, quick and irregular; coun- 
tenance flushed and swollen, though sometimes it is pale 
and anxious ; the tongue is white and shriveled ; skin cold 
and clammy; respiration difficult; intense thirst; urine 
scanty or suppressed ; cramps of the extremities ; stupor, 
fainting, convulsions and death. Salivation is apt to appear 
on the second or third day, but it is not an invariable symp- 
tom in acute cases. 

In some exceptional instances there has been an absence 
of abdominal pain, as also of vomiting and purging. 

Poisoning from corrosive sublimate differs from arsenical 
poisoning: (i) the former poison has a very distinct acrid 
taste, whilst the latter is almost tasteless. (2) The symp- 



CORROSIVE SUBLIMATE TREATMENT. 275 

toms of the former come on almost immediately after it is 
swallowed; those produced by the latter are generally post- 
poned for half an hour to an hour. (3) The discharges from 
corrosive sublimate poisoning are more frequently bloody 
than those from arsenic. 

The external application of corrosive sublimate has often 
been attended with fatal consequences, and both the symp- 
toms and post-mortem lesions, in such cases, resemble 
those produced by swallowing the poison, such as vomit- 
ing, purging, suppression of urine, salivation, etc., injection 
of the stomach and kidneys, with ecchymoses throughout 
the intestines and bladder. Cases of this character, result- 
ing fatally, are reported, where a solution of corrosive 
sublimate was applied to the scalps of children, for the cure 
of porrigo and ringworm. 

Fatal dose. — The minimum fatal dose for an adult may be 
considered to be three grains, although, as in the case of 
other mineral poisons, very large quantities have been taken 
with impunity, having been speedily vomited, or promptly 
neutralized by proper antidotes. 

Fatal period. — Dr. Taylor reports the shortest period on 
record, where death occurred in half an hour from an 
unknown amount of the poison. In the majority of cases 
life is prolonge'd for several days — from one to five. In a 
summary of cases given by Prof Guy {For en. Med. 1868, 
p. 475), about half the number died in less than twelve 
hours, and the remaining half in a period varying from 
three to eleven days. More than one-half the cases termi- 
nate fatally. 

Treatment. — Promote vomiting by the free use of warm 
diluent drinks. The proper antidote is albumen, as found 
in eggs. This decomposes the mercurial salt, forming an 
insoluble albuminate; a large excess of albumen will re- 



276 TOXICOLOGY. 

dissolve the precipitate. The white of one egg is supposed 
to be capable of neutralizing /^z^r grains of corrosive subli- 
mate. In the absence of eggs, gluten or wheat flour, in the 
form of paste, may be freely exhibited. Milk may also be 
freely used. 

Post-morte7n appearances. — These are generally confined, 
as in the case of arsenic, to the mucous membrane of the 
stomach and bowels, but the corrosive action of the mercu- 
rial is more marked. The stomach, together with the 
mouth, throat and oesophagus, is often softened, of a white 
or grayish color, and corroded. The slate-gray color is 
ascribed to the reduction of metallic mercury upon the 
lining membrane. The intestines, especially the caecum, 
often exhibit similar appearances. Perforation of the 
stomach is rare. The kidneys and bladder are usually 
highly inflamed, the former especially congested about the 
Malpighian bodies, and the epithelial cells deformed, gran- 
ular, and partially destroyed. The bladder is empty and 
contracted. 

According to Dr. Byasson (Woodman and Tidy, Med. 
Jiirisp. p. 204), corrosive sublimate takes two hours to reach 
the urine, and four hours to reach the saliva. He never 
found it in the perspiration. He considers it to be com- 
pletely eliminated in twenty-four hours after it has been 
taken. 

In chronic or slow mercurial poisoning, the symptoms 
generally presented are loss of appetite, metallic taste in the 
mouth, fetid breath, soreness of the gums, increase of 
salivary secretion, pain in the stomach and abdomen, with 
diarrhoea, quick pulse, hot skin, weakness and emaciation. 
A bluish line has been noticed at the edge of the gums, as 
in lead poisoning. 

Salivation, although often absent in acute mercurial poi- 



NON-MERCURIAL SALIVATION. 277 

soning, is nearly always observed in the chronic form. But 
as this symptom accompanies the use of many other drugs, 
it cannot, of itself, be regarded as a proof of the administra- 
tion of mercury. In a doubtful case, however, the matter 
may always be decided by a chemical examination of the 
saliva for mercury {vid. infra). Doubtless, other mineral 
poisons are eliminated by this secretion, and their presence 
might be detected in it, with proper attention. 

The relationship between salivation and mercurial poison- 
ing is a subject of considerable medico-legal importance, 
since charges of malpraxis have often been made against 
physicians in cases of profuse and fatal salivation, accom- 
panied by necrosis and gangrene, where, in some instances, 
no mercury whatever had been administered, and in others, 
where the dose has been exceedingly small. It is well 
known that there is no fixed, definite period when the sali- 
vation comes on ; rarely before two days, often later. A 
case reported by Dr. Wood {Ed. Med. and Surg, four., vol. 
LI, p. 141), in which a teaspoonful of corrosive sublimate 
had been swallowed, salivation was profuse in the course of 
a few hours. It has been suggested that this very early 
flow of saliva was probably due rather to the local irritant 
action of the poison, than to the result of absorption. 

An important fact, not to be lost sight of, in this relation 
is that salivation may be produced by various other agents 
besides mercurials, such as iodide of potassium, iodine, the 
preparations of copper, lead, bismuth, arsenic, antimony, 
digitalis, croton oil, cantharides, colchicum and other drugs. 
A case was recently mentioned to the author where a pa- 
tient was profusely salivated by a single dose of five grains 
of iodide of potassium. It is true that in the majority of 
the instances of non-mercurial salivation, there is an absence 
of the usual mercurial fetor of the breath and the coppery 



278 TOXICOLOGY. 

taste, but it would appear, from some recorded cases, that 
these symptoms have been equally noticed in the salivation 
produced by arsenic and bismuth. 

Another point of consideration for the legal physician is 
the great difference in the susceptibility of persons to the 
mercurial impression. Thus, it is almost impossible to 
salivate a very young, healthy, child. Certain morbid con- 
ditions of the system, however, seem to predispose to its 
action, as anaemia and albuminuria. We have known a dose 
of compound cathartic pills (containing only three grains 
of calomel) to produce very severe, ptyalism. Dr. Chris- 
tison states that three five-grain doses of blue pill, one every 
night, proved fatal; and that two grains of calomel have 
caused ulceration of the throat, exfoliation of the jaw, and 
death. 

Mercurial salivation may be intermittent, ceasing for a 
time, and reappearing without the further exhibition of the 
medicine during the Interval. 

Furthermore, salivation may arise spontaneously^ from 
mechanical irritation of the mouth, or as the result of 
exhausting diseases, especially among the children of pov- 
erty and squalor, who are surrounded by bad hygienic 
influences. Among the last-named subjects, the two dis- 
eases of cancrinn oris and of gangrene of the mouth are of 
frequent occurrence. The symptoms of these conditions 
strongly resemble a very severe case of mercurial ptyalism, 
so that the diagnosis may be difficult. If, in such a case, 
the physician should have happened to have administered, 
at the beginning of the sickness, even a small dose of 
calomel, it might easily become a serious question to deter- 
mine whether the death actually resulted from the mercury 
acting as a poison, or from the disease ; and it would be no 
difficult matter to get up an action against the medical man 






CORROSIVE SUBLIMATE — ANALYSIS. 279 

for alleged malpraxis. Dr. Taylor cites a case in point 
[On Poisons, p. 406). A charge was made against a medical 
practitioner for having caused the death of a child, aged 
four years, by administering an overdose of some mercurial 
preparation, for the treatment of whooping cough. On the . 
fourth day the child complained of soreness of the mouth; 
the teeth became loose and fell out ; the tongue and cheek 
were much swollen, and the child died, in the course of a 
few days, from gangrene of the left cheek. The answer to 
the charge was, that not a particle of mercury had been 
given — a fact clearly proved from the prescription-book of 
the medical attendant. This was clearly an instance in which 
gangrene from spontaneous causes had been mistaken for 
mercurial poisoning. As before observed, the chemical 
analysis of the saliva would settle any question of this 
kind. 

Chemical analysis. — (i.) As a solid. — {a) A fragment heated 
on platinum foil is entirely dissipated in white, acrid fumes, 
which condense on a cool surface in white, radiating crys- 
tals. (8) Touched with a drop of liquor potassse, it turns a 
yellowish color ; calomel, under similar circumstances, be- 
comes black, if) A solution of iodide of potassium imparts 
a bright scarlet color; this is a very delicate test. A drop 
of this latter solution placed upon a piece of bright copper, 
in contact with the smallest fragment of corrosive sublimate, 
will produce a bright, silvery stain upon the copper, 
especially if it be rubbed with the finger ; this stain is imme- 
diately removed by heating it. (d) Sulphide of ammonium 
at first turns it yellowish, but subsequently black, {e) Heated 
in a reduction-tube with dried carbonate of soda, it sublimes, 
forming a white ring on the cool part of the tube, which, 
under the microscope, is seen to consist of minute globules 
of metallic mercury. The white residue in the tube is 



280 TOXICOLOGY. 

shown to contain chlorine, by dissolving it in water and 
applying nitrate of silver. 

(2.) As a liquid. — {a) A drop evaporated on a glass slide 
will yield large, needle-shaped or prismatic crystals. (^) So- 
lution of potassa gives a yellow oxide of mercury ; this, 
when dried and heated in a reduction-tube, will yield a 
sublimate of mercury globules, with the evolution of oxygen 
gas. {c) Aimnonia produces a ivhite precipitate, (d) Iodide 
of potassium first causes a j^Z/^^e' and immediately afterwards 
a bright scarlet precipitate, soluble in an excess of the re- 
agent When this iodide of mercury is dried and heated, 
it volatilizes, and condenses in a yellow deposit, which 
gradually changes to scarlet, (e) Protochloride of tin first 
throws down a white precipitate (calomel), and, if in excess, 
a dark gray precipitate (metallic mercury), which runs into 
globules on being boiled, (y) Sulphuretted hydrogen and 
sulphide of ammonium first cause a whitish precipitate, 
soon changing to red, and ultimately to black. (^) The 
copper test. A piece of bright copper put into a cold 
solution of corrosive sublimate, acidulated with hydrochloric 
acid, speedily acquires a silvery white coating of metallic 
mercury. When the copper slip is dried and heated in a 
reduction-tube, a sublimate of metallic globules is obtained, 
easily identified by the microscope. This test is extremely 
delicate, and will detect the xoioo of a grain, \i the copper 
surface is very small and is heated in a very small tube. 
According to 'VJornAoy {Micro- Chem. of Poisons, p. 339), a 
far smaller quantity — even the 500^^0077 of a grain — may be 
identified by employing a very small, thin, glass tube, the 
one-tenth of an inch in diameter, and drawing it out, by 
heating, into a thin capillary neck. The small fragment of 
coated copper is introduced through the wider portion of 
the tube to the point of contraction, and the wider end is 



CORROSIVE SUBLIMATE TESTS. 281 

now carefully fused shut by the mouth blowpipe, so as to 
give it the appearance of a small thermometer tube, the 
bulb containing the coated copper. The tube is now heated 
at the bulb, and the capillary end closed. On examination 
under the microscope, a well-defined ring of mercurial 
globules will be visible on the capillary tube, just above the 
bulb. 

In case the mercurial sublimate in the reduction-tube 
should be dim and unsatisfactory, Tardieu (^Sur /' Einpois.^ 
p. 580) recommends to introduce a minute crystal of iodine 
into the tube, pushing it down as far as the sublimate with 
a platinum wire. The open end of the tube is then stopped 
with wax, and it is kept in a horizontal position for about 
twelve hours, at a temperature of 30° or 40° C, when the 
deposit will assume a bright scarlet color, due to the pro- 
duction of iodide of mercury. After removing the iodine, 
the tube may be gently and progressively heated from 
below by the flame of a spirit lamp, when the scarlet color 
will change to yellow, and on cooling the latter color will 
give place to scarlet again. 

(Ji) The galvanic test. — This consists in winding a strip 
of gold around a strip of zinc (or iron) and placing the coil 
in the acidulated solution. Prof. Guy recommends a simpler 
and equally certain method — to moisten a narrow slip of 
zinc with water, and to take up as much gold leaf as will 
adhere to it, and introduce this into the acid solution. The 
gold will, in a short time, become coated over with a silver- 
colored coating of mercury. It is then to be carefully 
washed and dried, and heated in a reduction-tube, when the 
usual mercurial sublimate will be obtained. The gold test 
is generally regarded as the most delicate of all. 

Toxicological examination. — In a case where the poison 
was administered in the solid form, fragments of it may be 
13* 



282 TOXICOLOGY. 

found in the stomach yet undissolved ; these should be col- 
lected and identified. But as corrosive sublimate is easily 
decomposed by albumen, gluten and other substances, 
much of it may be changed into insoluble compounds. If 
the quantity in solution is considerable, it may be extracted 
by simply agitating it with twice its volume of ether, and 
after it has settled, removing the ether by means of a pipette, 
and allowing it to evaporate spontaneously, when the salt will 
crystallize in white, silky prisms. These may be purified, if 
necessary, by dissolving in water or alcohol, and again 
crystallized. This method has the advantage of recovering 
the poison in the exact state in which it was swallowed, with 
the reservation, however, that ether would act upon any 
mercurial salt in the presence of an alkaline chloride — e. g., 
chloride of sodium — in a similar manner. 

The stomach and its contents should be prepared in the 
usual manner, already described, and heated with distilled 
water and hydrochloric acid. After proper filtration and 
concentration, a trial test may be made with a strip of cop- 
per, allowing this to remain in the solution, if necessary, for 
several hours. The gold test may be applied in a similar 
manner. By either of these processes the metal can be 
recovered in a satisfactory manner. The other tests above 
mentioned may also be applied as corroborative proofs. 

The solid matters remaining, after straining off the liquid, 
will probably contain much of the poison combined with 
organic substances. These should be boiled in distilled 
water with hydrochloric acid, until disintegrated, then fil- 
tered and concentrated, and tested as above. Another 
method is to dry the solid matters thoroughly, and digest 
them in warm nitro-muriatic acid, by which the insoluble 
mass is converted into soluble corrosive sublimate. The 
acid liquid is then evaporated to dryness , the residue dis- 



CORROSIVE SUBLIMATE DETECTION. 283 

solved in water and filtered, and the usual tests applied; or 
the corrosive sublimate is dissolved out by ether. 

In the tissues. — The liver, or other organs, should first 
be crushed in a mortar, with sufficient alcohol to render 
filtration easy. Acidulate the mass with hydrochloric acid, 
and gently warm for some time ; then filter through paper, 
and apply the copper or galvanic test, and sulphuretted 
hydrogen to the filtrate. All the solid portions are now to 
be mixed with water and four parts of hydrochloric acid, 
and boiled for some time ; when cool, they are to be filtered 
and the filtrate examined as above. 

Should arsenic happen to be present in the tissues along 
with corrosive sublimate, on the application of Reinsch's 
test both metals will be precipitated on the copper, and both 
will sublime from the latter when it is heated in the reduc- 
tion-tube ; but in the cold, mercury alone will be deposited 
on the copper. 

To detect mercury in the saliva, acidulate about two 
drachms of this fluid with one-fourth of hydrochloric acid, 
and introduce into the mixture a small piece of bright cop- 
per foil, and the whole kept warm for several hours. The 
silvery deposit on the metal will indicate the presence of 
mercury, which will be confirmed by heating it, when washed 
and dried, in a reduction-tube, and procuring the character- 
istic mercurial globules by sublimation. 

In examining the urine, evaporate about twelve or four- 
teen ounces down to one ounce ; acidulate this with hydro- 
chloric acid; filter and boil the filtrate, and introduce a 
fragment of bright copper, and confirm as directed above. 

It should be remembered that death may ensue from cor- 
rosive sublimate, and no mercury be found in the tissues, as 
where the person has survived for a number of days. Also, 
as in the case of other poisons, there may be a failure to 



284 TOXICOLOGY. 

detect it in the stomach after death, even when large doses 
had been swallowed. 

On the other hand, the detection of minute quantities of 
mercury in the organs is not always evidence of poisoning, 
inasmuch as the person may have lately taken blue pill or 
calomel as a medicine ; hence, caution should be exercised 
in reference to this point. 

Corrosive sublimate is usually estimated quantitatively, 
as a sulphide, by carefully washing and drying the pre- 
cipitate obtained by sulphuretted hydrogen. Every lOO 
grains of dried sulphide are equivalent to 116.81 grains of 
anhydrous corrosive sublimate. Sometimes the proto- 
chloride of tin is used to precipitate metallic mercury from 
a given quantity of the mercurial solution. The globules 
should first be purified by boiling them in a solution of 
potassa, and afterwards in hydrochloric acid. Every 100 
grains of metallic mercury represent 135.5 grains of cor- 
rosive sublimate. 

Other compounds of mercury may occasionally prove 
poisonous, as the red and white precipitates, red oxide, calo- 
mel, the sidphides, 7iitrates and sidphates. 



POISONING BY LEAD. 285 



CHAPTER XX. 

POISONING BY LEAD. 

FREQUENCY OF CHRONIC POISONING. — ACETATE OF LEAD. — SYMP- 
TOMS. — TREATMENT. — POST-MORTEM APPEARANCES. — PAINTERS' 
COLIC. — LEAD PALSY. — TOXICOLOGICAL EXAMINATION. 

In the metallic state, lead is not considered poisonous ; 
but, as it is easily oxidized by the fluids of the stomach, it 
would soon be converted into a deleterious compound. All 
its salts are poisonous, with perhaps the single exception of 
the sulphate^ which is very insoluble. 

Acute poisoning by lead is very rare, except as the result 
of accident. On the other hand, chronic, or slow lead- 
poisoning is of frequent occurrence, since there is no metal 
more constantly and insidiously introduced into the human 
system than lead, under its varied forms. In the arts, the 
workmen in this metal inhale the fumes and powders in 
smelting the ores, and manufacturing white lead. Painters, 
plumbers, pewterers, and glazers of pottery are all exposed 
to similar danger. Even sleeping in a freshly-painted room 
has been known to cause an attack of colic and paralysis, 
from breathing the emanations containing carbonate of lead. 
Dr. Taylor [On Poisons, p. 434) alludes to himself as having 
suffered from this latter cause. 

The frequent handling of pewter vessels, and especially 
of new type, has produced lead palsy. The use of glazed 
pottery is another source of contamination, arising from the 
action of acids, such as vinegar, and of oils and fats, also of 
alkalies, on the glaze, which consists of litharge. Even 



286 TOXICOLOGY. 

'inilk has become poisoned in this way. Cider and beer, 
drawn through leaden pipes, may become contaminated in 
the same manner. Wine may become affected by contact 
with the shot left in the bottles through carelessness. New 
rum is apt to contain lead, derived from the leaden worm of 
the still, while old rum is free from this adulteration. This 
is ascribed, with great probability, to the fact that old rum, 
being kept in oak casks, is deprived of its lead by the tannin 
of the cask. 

Certain medicinal substances often contain lead, derived 
from the mode of their manufacture ; thus, carbonate of 
a7n7nonia, sublimed in leaden vessels; dorax^ Sind other salts, 
crystallized in leaden pans ; tartaric acid, from the lead 
attached to the strings used in its crystallization. Solutions 
of soda and potash, when kept in flint-glass bottles, soon 
become impregnated with lead ; and the sulphuric acid of 
common use almost invariably contains lead, derived from 
the leaden chambers. 

Many articles in domestic use are not unfrequently con- 
taminated by lead, as flour (from the plugs of lead imbedded 
in the millstones), sugar, snuff, tobacco, chocolate, and bon- 
bons — the latter articles from the impure tin-foil wrappers. 

The external application of the preparations of lead is 
often the cause of slow poisoning, as in handling the metal, 
already alluded to ; the use of hair dyes and cosmetics ; and 
even from the glazed lining of hats. The direct application 
of white lead to the scalded surface, as a dressing, has been 
known to produce symptoms of lead colic. 

Probably the most frequent source of chronic lead poison- 
ing is through drinking water, which has, in some way or 
other, been in previous contact with metallic lead. The con- 
ditions under which this occurs should be thoroughly un- 
derstood by the legal physician. Pure distilled water, which 



ACETATE OF LEAD. 287 

in nature is represented by rain and melted snow, in contact 
with lead and exposed to the air, speedily acts upon the 
metal, producing a mixture of the hydrated oxide and car- 
bonate of lead, which are very poisonous. Consequently, 
rain water, which is frequently preserved in cisterns for 
drinking purposes, should never be collected from a leaden 
roof, nor be conducted through leaden pipes, nor in any way 
come in contact with this metal. On the other hand, river 
and spring water, which always contain more or less of saline 
ingredients, exert no deleterious influence upon lead, in con- 
sequence of the preservative action of the carbonates, sul- 
phates and phosphates existing in the water ; these form an 
insoluble film or coating upon the surface of the metal, thus 
preserving it from any further action of the water. The 
presence of the chlorides, nitrates and nitrites would, on the 
contrary, increase its corrosive action on the lead. Free 
carbonic acid in the water very much increases the danger 
of contamination, in the absence of any protecting salt, in 
consequence of its solvent power over carbonate of lead. 

Another cause of contamination may arise from a gal- 
vanic action between lead and other metals soldered together, 
and especially when in contact with carbonic-acid water. 
Danger also arises from a leaden cover being over a pump 
or cistern. The vapor of the water (which is equivalent to 
distilled water), impinging on the metal surface, dissolves 
off the poisonous oxide and carbonate of lead, which may 
in time fall into and contaminate the water. 

The only compounds of lead, of medico-legal interest, 
are the acetate and carbonate. 

Acetate of Lead — {Sugar of Lead). — Occurs in com- 
merce in masses of white, or light-brownish crystals, some- 
what resembling loaf sugar in appearance. It has an acetous 
odor, and a sweetish, astringent taste. Soluble in water; less 



288 TOXICOLOGY. 

so in alcohol. Its aqueous solution becomes milky on ex- 
posure to the air, owing to the carbonic acid of the latter. 

It is not a very active poison ; it is much used in medical 
practice, but its continued employment has occasionally re- 
sulted in bringing on symptoms of lead poisoning. 

In doses of an ounce or two, it acts as a powerful irritant, 
causing burning pain in the throat and stomach, and thirst, 
vomiting, twisting, colicky pains, with tenderness in the abdo- 
men, obstinate constipation, retraction of the abdominal 
walls, anxious countenance, cold sweats and convulsions. 
The urine is diminished in quantity. In protracted cases, 
there is often paralysis of one or more of the extremities. 
Its influence on the nerve centres is marked by the giddi- 
ness, stupor, convulsions and coma. In some cases, there 
is purging of bloody matters, though usually the fecal dis- 
charges are hard, dry and black. The peculiar blue line 
upon the edge of the gums, characteristic of chronic lead 
poisoning, may sometimes be observed in acute cases. 

The fatal quantity is uncertain; an ounce has been 
swallowed with impunity, though a less quantity has 
occasioned alarming symptoms. Th.Q fatal period is equally 
uncertain, varying from a few hours to several days. 

The proper antidotes are the soluble alkaline and earthy 
sulphates, especially the sulphate of magnesia, which forms 
the insoluble sulphate of lead. At first, however, vomiting 
should be promoted by sulphate of zinc ; afterwards, opium 
and castor oil may be required. The urine should be 
frequently examined for the presence of the metal. 

Post-mortem appearances. — Often no well-marked lesions 
are discoverable. Again, more or less inflammation of the 
alimentary tract has been observed. Sometimes the inner 
coat of the stomach and bowels is covered with a thick, 
whitish layer of mucus mixed with the salt of lead, beneath 



POISONING BY LEAD LEAD COLIC. 289 

which the membrane is reddened, or even abraded. The 
intestines are generally found contracted. As regards 
chronic cases, there is nothing very definite to record, 
except the contraction of the large intestines, and the 
flabby and whitish appearance of the muscles specially 
affected. 

Chronic poisoning. — This may result from the continued in- 
ternal use of any of the salts of lead ; but it is more frequently 
produced among artisans working in white lead and litharge, 
or by the accidental introduction of the metal into the sys- 
tem through drinking-water, or articles of food. The earlier 
symptoms are grouped under the names of Lead Colic, 
Painters' Colic, or Colica Pictonnm ; the later symptoms are 
named Lead Palsy. 

Lead colic. — The earlier symptoms are obstinate consti- 
pation and indigestion, with great depression. Then there 
is a feeling of twisting, grinding pain about the umbilicus, 
which may be rather relieved by pressure. The abdomen 
is hard and retracted ; sometimes there are scanty, hard 
evacuations, with much sufifering. The urine is scanty, and 
voided with difficulty. The countenance is dull and anxious ; 
skin cold and clammy; pulse about natural; respiration 
quick and catching; loss of appetite, with dryness of mouth 
and throat ; the breath is fetid, and often a metallic taste in 
the mouth. A characteristic sign of saturnine poisoning 
is the blue line at the margin of the gums, where they join 
the teeth, especially noticeable on the upper incisors. This 
is due to the deposition of the metal in the form of a sul- 
phide in the capillaries of the gums, as can be shown by the 
microscope. Some other metals, as silver and mercury, 
occasionally produce a somewhat similar blue line, and it is 
wanting in some exceptional cases of chronic lead-poisoning. 
When once established, this symptom is very persistent. 



290 TOXICOLOGY. 

Lead palsy. — Lead colic, if allowed to continue un- 
checked, is very apt to terminate in paralysis, especially 
after repeated attacks of the former. Again, it may come 
on without any previous attack of colic. It usually affects 
the upper extremities. At first there is a dull, numb feel- 
ing in the skin of the fingers and forearms, trembling of the 
arms and legs, unsteadiness of gait, loss of power in the 
hands and arms, which gradually waste away. The ex- 
tensors are more affected than the flexors, so that, when the 
arm is raised, the hand drops by its own weight, whence 
the common name of " wrist drop " for this disease. If un- 
checked, brain symptoms present themselves, such as giddi- 
ness, torpor and apoplexy; sometimes there are epileptic 
fits, oedema, albuminuria and convulsions, ending in coma 
and death. 

Lead has been found, after death, in the brain, and 
especially in the gray matter of the spinal cord, also in the 
bones, liver and kidneys. Doubtless, many cases of obscure 
spinal, cerebral and cardiac disease are really owing to 
chronic lead poisoning — the metal having been introduced 
unsuspectedly into the system. 

Chemical analysis. — I. In the solid state. — Heated in a 
test-tube, it evolves an acetous odor, and fuses into a white 
mass ; if the heat is continued, it again fuses and slowly 
chars, and is converted into a reddish-brown mixture of the 
oxides of lead. Heated on charcoal, before the blowpipe, 
it is converted into globules of metallic lead, with a sur- 
rounding incrustation of yellow oxide. A fragment dropped 
into a solution of the iodide of potassium instantly turns 
yellow; touched with sulphide of ammonium it immediately 
is blackened. 

II. In the liquid state. — (i) A drop, evaporated on glass, 
yields opaque needles, which turn yellow when touched 



LEAD TOXICOLOGICAL EXAMINATION. 291 

with a drop of iodide of potassium solution, or solution of 
bichromate of potassium; or black, by sulphide of ammo- 
nium. (2) Dilute sulphuric acid causes a white precipitate, 
soluble in hot hydrochloric acid, and in large excess of 
potassa and soda. (3) Iodide of potassium gives a bright 
yellow precipitate, soluble in boiling water, which deposits 
it in brilliant yellow scales, on cooling. The iodide of lead 
is also soluble in potassa and strong hydrochloric acid. 
(4) Bichromate of potassium gives a bright yellow precipi- 
tate. (5) Sulphuretted hydrogen is the most delicate test, 
revealing, according to Taylor, a quarter of a grain of this 
salt in a gallon of water. The black sulphide is confirmed 
by heating it on charcoal, before the blowpipe ; or by dis- 
solving it in nitric acid, by the aid of heat, evaporating to 
dryness, dissolving in water, and applying the usual tests. 
(6) The galvanic test. — A drop or two of the solution, 
slightly acidified with acetic acid, is put into a platinum 
capsule, and a strip of zinc is made to touch the platinum 
through the liquid ; crystals of metallic lead are deposited 
on the zinc; or a fragment of zinc maybe placed in the lead 
solution in a watch glass, when very soon metallic lead will 
be deposited upon the zinc in an arborescent form. A salt 
of tin, under similar circumstances, would yield an arbores- 
cent deposit of tin. Hence, the metallic deposit must be 
further tested by dissolving it in nitric acid, and applying 
the usual tests. 

Other tests of minor importance are potassa and am- 
monia, oxalate of ammonium, alkaline carbonates, and red 
and yellow prussiate of potassium. 

Toxicological examination. — As acetate of lead is easily 
decomposed by many organic substances, such as albumen, 
casein, mucus, etc., the poison may exist both in the soluble 
and insoluble condition. As a trial test, a good plan is to 



292 TOXICOLOGY. 

wet a piece of bibulous paper in the suspected solution and 
expose it to a jet of sulphuretted hydrogen gas, which will 
blacken it, if it contains any lead. If the presence of this 
metal be indicated, the mixture should be acidulated with 
pure nitric acid, and boiled for some time ; when cold, it 
should be filtered, and the solids on the filter thoroughly 
washed, and reserved for future examination. Concentrate 
the filtrate by evaporation, and treat with sulphuretted hy- 
drogen ; allow the precipitated sulphide of lead to collect, 
pour off the supernatant water, boil in dilute nitric acid, add 
sufficient distilled water, filter, and apply the usual tests 
(p. 291). 

The solids on the filter should be dried, and incinerated 
in a porcelain capsule; dissolve the ash by heat in dilute 
nitric acid, filter, and treat with sulphuretted hydrogen, and 
prove the precipitated sulphide. 

If an alkaline sulphate has been given as an antidote, a 
white precipitate of sulphate of lead may be found in the 
stomach. This should be collected and boiled with pure 
potassa (proven itself to contain no lead), and the solution 
tested with sulphuretted hydrogen. 

The solid organs (liver, spleen, etc.) may be examined 
either by boiling with nitric acid and water, evaporating to 
dryness, incinerating in a porcelain crucible and again dis- 
solving by heat and dilute nitric acid, or by directly 
incinerating them in a porcelain crucible and dissolving out 
the lead with strong nitric acid, evaporating to dryness, 
diluting with water, and precipitating with sulphuretted 
hydrogen. 

As lead remains in the system for a considerable time, in 
case of the detection of only a minute quantity in the body 
after death, inquiry should always be instituted in reference 
to the possibility of its accidental introduction into the sys- 



LEAD DETECTION. 293 

tern through the occupation, mode of living, etc., of the 
individual. 

The examination of the urine should never be neglected, 
seeing that lead is eliminated from the system chiefly 
through this secretion. From fifteen to twenty ounces of 
urine, acidulated with nitric acid, should be evaporated to 
dryness, and incinerated as above directed, and the ash 
treated as already described. 

For the detection of lead in sweetmeats, etc., suspected 
of being colored with this metal, slightly moisten them with 
water and put them on a plate, placing in the centre a little 
capsule containing about a drachm of sulphide of ammo- 
nium, and cover the whole with a tumbler. If lead be 
present, the sweetmeats will, after a short time, be blackened 
by the sulphuretted hydrogen gas evolved {Woodman and 
Tidy). 

Lead is quantitatively determined as a sulphide. Every 
lOO parts of pure, dried sulphide represent 93.31 parts of 
the oxide, or 158.37 parts of crystals of the acetate. 



294 TOXICOLOGY. 



CHAPTER XXL 

POISONING B-Y COPPER. 

ACCIDENTAL POISONING. — SALTS OF COPPER. — FATAL DOSE. — TREAT- 
MENT. — MORBID APPEARANCES. — CHEMICAL ANALYSIS. — TOXICO- 
LOGICAL EXAMINATION. 

Copper, like many of the other metals, is not poisoiious 
in the metallic state ; but if taken into the stomach, it is 
soon corroded, and forms highly poisonous compounds. 
Copper coins, sometimes swallowed by children, may thus 
produce dangerous results. The inhalation of copper alloy 
in fine powder, by artisans who work in what is termed 
gold printing, causes serious results, such as constriction 
and heat of throat, vomiting, loss of appetite, and severe 
itching of the parts of the body covered with hair, which, 
on examination, are found to be of a deep green color 
{Falconer, on Copper Poisoning). 

Cases of accidental copper-poisoning can frequently be 
traced to want of cleanliness in cooking, or to keeping food 
in copper vessels, particularly such articles as contain a 
vegetable acid, as vinegar, an alkaline chloride, as common 
salt, or any kind of oil" or fat. So long as copper utensils 
are kept perfectly clean and bright, no risk is incurred in 
using them ; but if cleanliness is neglected, a deposit of the 
green carbonate collects, which is very poisonous, and will 
contaminate any food with which it may come in contact. 
There is no risk in boiling articles of food or preserves in 
clean copper vessels, although it is unsafe to keep these 
articles, cold, in the same vessels; in the latter case, the 
atmospheric air acts upon the metal at the point of contact 



POISONING BY COPPER. 295 

of the contained substance. Dr. Falconer gives an instruc- 
tive example of this. A servant left some sour-krout, for 
only a couple of hours, in a copper pan which had lost its 
tinning. Her mistress and daughter, who ate of the cab- 
bage, died after twelve hours' sickness. Wildberg found 
the cabbage so strongly impregnated with copper that it 
was detected by metallic iron. 

The inference from the above facts would be that it is 
extremely unsafe to employ copper vessels either for cook- 
ing, or still more so for preserving articles of food. Even 
tinned copper vessels are not safe, because the tinning con- 
sists of an alloy of tin and lead, and the latter metal might, 
in its turn, prove a source of danger. 

The alloy termed Z^/^^(f/2 metal, used for ornamenting cakes 
and confectionery as a substitute for gold leaf, may also 
prove a source of poisoning, as likewise the blue and green 
papers used as wrappers for bon-bons, although the chief 
source of danger from the latter arises from the arsenic con- 
tained in their composition. 

The fine green color on many samples of pickles and 
preserved fruits is owing to the adulteration of a salt of 
copper, as verdigris or blue vitriol. This may be easily de- 
tected by placing the suspected article in ammonia, when, if 
copper be present, it will turn blue. A simpler method is to 
plunge a bright needle into the article; if copper be present, 
it will speedily receive a reddish coating of the metal. 

All the cupreous salts are poisonous ; those of most 
medico-legal importance are the sulphate (blue vitriol, blue 
stone), and the sub-acetate (verdigris). The arsenite and 
aceto-arsenite have already been described under the head 
of Arsenic. What is commonly called verdigris is the car- 
boiiate of copper, which is produced by the action of moist 
air on the metal, or on brass. 



296 TOXICOLOGY. 

The salts of copper are rarely used for homicidal poi- 
soning, as they can be so readily recognized, both by their 
color and taste. Occasionally, they have been taken 
suicidally, and more rarely by accident. The sulphate has 
been employed as an abortive. 

Symptoms. — The sulphate may be taken as a type of all 
the salts. In large doses it produces speedy and powerful 
vomiting, which would probably expel the whole of the 
poison, and thus prevent a fatal result. There are pain in the 
stomach and bowels, great thirst, purging, headache, pros- 
tration, small, frequent pulse, with increased flow of saliva. 
The matters vomited are bluish or greenish ; those from the 
bowels are greenish, and tinged with blood. Sometimes 
there are severe cramps and convulsions. There is also 
suppression of urine, and in fatal cases, paralysis and tetanus 
have preceded death. Jaundice is also an occasional result. 
Dr. Tidy speaks of it as "the specially diagnostic symptom 
of copper poisoning." It is not met with in poisoning by 
either arsenic or mercury. 

The symptoms of slow poisoning (which is generally the 
result of the accidental introduction of the metal in articles 
of food) are an acrid, styptic, coppery taste in the mouth, 
dry and parched tongue, coppery eructations, continual 
spitting, nausea and vomiting, colicky pains in the bowels, 
diarrhoea of bloody stools, with tenesmus, great thirst, heat of 
skin, small and tense pulse, scanty urine, headache, vertigo, 
faintness, cramps of the legs and convulsions; occasionally, 
jaundice and a blue line on the margin of the gums. 

Fatal dose. — Not positively determined. Half an ounce 
of verdigris has proved fatal, and an ounce of the sulphate; 
but larger quantities have been swallowed without produc- 
ing death. The usual emetic dose is five to fifteen grains. 
The usual fatal period is from four to twelve hours. 



COPPER CHEMICAL ANALYSIS. 297 

Treatment. — Free vomiting should be assisted by the use 
of warm diluent drinks. The best antidote is albumen in 
the form of white of eggs, as for corrosive sublimate. Milk 
is also very useful. 

Morbid appearances. — These indicate the action of a 
powerful irritant to the mucous membrane of the alimen- 
tary canal, from the throat downward. The lining mem- 
brane of the stomach is inflamed, softened, and sometimes 
ulcerated. It usually exhibits a bluish or greenish appear- 
ance, due to the color of the salt taken. The same is true, 
also, of the intestines. As a somewhat similar appearance 
may result from the presence of bile, it is proper to distin- 
guish between them by the addition of ammonia, which will 
impart a deep blue color if copper is present, but will cause 
no change in the green color, if due to bile. Perforations 
have been found in the small intestines ; the rectum is occa- 
sionally ulcerated, and the lungs congested. 

Chemical analysis. — All the salts of copper possess either 
a blue or green color. Only a few other metallic salts are 
thus colored, as some of the cobalt salts, blue, and some 
of those of nickel, chronium and uranium, green. When 
heated in the blowpipe flame, they impart to it a beautiful 
green color ; and when heated on charcoal, with dry carbo- 
nate of soda, before the blowpipe, globules of metallic 
copper are obtained. 

The sulphate, or blue vitriol, occurs in large, handsome 
crystals, efflorescent, soluble in water, having a nauseous, 
styptic, metallic taste. The verdigris of commerce occurs 
in masses of a light green, or bluish-green color. It is a 
mixture of the sub-acetate and other acetates of copper. It 
is soluble in water and in dilute acids. 

(i) Ammonia gives to the solution a bluish-white amor- 
phous precipitate — hydrated oxide of copper, which is re- 
14 



298 TOXICOLOGY. 

dissolved by an excess of the precipitant, yielding a beautiful, 
clear, dark purple-blue solution ; this color is immediately 
removed by an acid. The salts of cobalt, nickel and 
chromium give somewhat similar results. 

(2) Ferrocyanide of potasshim gives a reddish-brown pre- 
cipitate, insoluble in excess of the reagent, but soluble in 
ammonia. If the copper solution be very dilute, no pre- 
cipitate may take place, but only the distinct brownish-red 
discoloration. We have found this test rather more delicate 
than that of ammonia. 

(3) Sulphuretted hydrogen, or sulphide of * ammonium 
yields a brownish-black precipitate of the sulphide. This 
should be corroborated by boiling in nitric acid, evaporating 
to dryness, dissolving in water, and applying the usual tests. 

(4) The iro7i test. — This simple and satisfactory test con- 
sists in immersing a piece of bright iron or steel in a 
slightly acidulated solution of copper, when, sooner or 
later, according to the strength of the solution, it will 
acquire a red coating of metallic copper. If the solution be 
very dilute, it should be concentrated by heat, and a very 
small iron surface should be exposed ; a fine sewing needle 
may be suspended in it for some hours. After it has 
received the copper coating, it may be removed and put 
into a porcelain capsule, with a little ammonia, which, in a 
short time, will assume a blue color. 

(5) The galvanic test consists in placing the copper solu- 
tion, slightly acidulated, in a platinum dish, and touching 
the latter, through the liquid, with a piece of zinc. The 
metallic copper will be deposited on the platinum, in the 
form of a reddish incrustation. The latter maybe dissolved 
off the platinum by dilute nitric acid, evaporating to dry- 
ness, moistening it with water, and testing it as above di- 
rected. 



COPPER — TOXICOLOGICAL EXAMINATION. 299 

(6) The blowpipe, as already mentioned. 

Toxicological examination. — A portion of the copper may 
be found in a soluble, and some in an insoluble state. The 
liquid part has usually a bluish or greenish color. This 
should be filtered, concentrated by heat, and a trial test, by 
means of a bright sewing needle, applied. Any reddish de- 
posit on the latter should be proved, as above mentioned. 
Sometimes the needle may acquire a reddish coating simply 
from the oxide of iron : ammonia will serve to distinguish 
them. If a large amount of copper should be indicated, 
sulphuretted hydrogen should be passed through it until all 
the metal is precipitated as a sulphide. This is to be treated 
after the manner before described. If the amount of copper 
be extremely small, the galvanic test is the most suitable. 
The filtered liquid, acidified with sulphuric acid, is placed in 
a platinum capsule, and fragments of pure zinc are put into 
it; wherever there are points of contact between the two 
metals, there will be a reddish deposit on the platinum. This 
should be washed, and the copper dissolved off with a drop 
or two of dilute nitric acid. The nitric solution is to be 
evaporated to dryness, diluted with water, and tested as 
before described. 

If neither of the above tests reveal the presence of copper, 
it cannot be present in the liquid matters ; but the solids 
may possibly contain it. These should be boiled with dilute 
hydrochloric acid and water, filtered, concentrated by heat, 
and tested. 

Traces of arsenic are sometimes found In the sulphate; 
when the latter has been taken as a vomit, traces of this 
substance have been discovered in the matters vomited, and 
in the stomach (Taylor). 

In searching for the salts of copper in the stomach, this 
organ should be carefully examined for blue or green par- 
ticles. After treating the stomach and its contents In the 



300 TOXICOLOGY. 

usual manner, with the addition of water and hydrochloric 
acid, and filtering and concentrating by heat, the iron and 
galvanic tests may be used as trial tests. Sulphuretted hy- 
drogen gas should then be passed through the liquid until 
all the sulphide of copper is precipitated. This should be 
boiled in dilute nitric acid, evaporated to dryness; if much 
organic matter is present, it should be moistened with strong 
nitric acid and heated until all the organic matter is de- 
stroyed. The dry residue is now dissolved in dilute nitric 
acid, and again evaporated to dryness, dissolved in water, 
and the usual tests applied. 

In the organs. — These should be finely divided and 
thoroughly dried, and then incinerated in a porcelain 
crucible, and the resulting ash treated with pure hydro- 
chloric acid by heat, and then evaporated to dryness ; dis- 
solve in water, and apply the usual tests. Copper remains 
longer than arsenic in the tissues and organs ; as long as 
sixty days in the liver and lungs, according to M. L. Orfila. 

In the urine. — Evaporate six to eight ounces to dryness ; 
treat the residue with the nitric acid and chlorate of potas- 
sium, with the aid of heat, to complete incineration. Dis- 
solve the resulting ash in hot dilute nitric acid, and evapo- 
rate to dryness. Dissolve the residue in warm water, and 
test as above. 

Copper is not a normal constituent of the human body. 
It exists in minute proportions in certain vegetables, which, 
doubtless, obtain it from the soil. 

The discovery of faint traces of copper in the body after 
death is no proof of copper-poisoning, since it may have 
been introduced into the system accidentally, either through 
the food, or otherwise. 

Copper is determined quantitatively as the black oxide, 
every lOO parts of which are equivalent to 314.21 parts of 
crystallized sulphate. 



POISONING BY ZINC. 301 



CHAPTER XXII. 

POISONING BY ZINC, BISMUTH, TIN, IRON AND CHROMIUM. 
SECTION I.— POISONING BY ZINC. 

Cases of zinc-poisoning are comparatively rare. In the 
metallic state, zinc is probably inert ; but if swallowed, it 
would soon be acted upon in the stomach, and converted 
into a salt, where it might occasion serious results. The 
sulphate and chlonde are the preparations most likely to 
produce poisonous effects. 

The zinc of commerce (spelter) is apt to contain arsenic 
and other impurities. 

Sulphate of zinc — White vitriol, — A white, crystalline, 
soluble salt. It has a metallic, astringent taste ; effloresces 
on exposure to the air. It acts as a prompt, active emetic, 
without causing much depression of the system ; hence, is 
indicated in cases of narcotic poisoning. It is used in small 
doses as a nerve tonic, and the system soon acquires a 
tolerance of the medicine. As much as two scruples three 
times a day, have been given for a period of three weeks, in 
a case of epilepsy. 

Poisonous dose. — Half an ounce, to an ounce. 

Symptoms. — A strong, metallic taste, attended with a 
burning sensation, and constriction of the throat, nausea, 
violent vomiting, intense pain of stomach and bowels, 
purging, small and frequent pulse, great anxiety, cold 
sweats, extreme prostration, dilated pupils, coma and death. 
Experiments on animals show it to be a powerful heart 
depressant. 



302 TOXICOLOGY. 

Fatal period. — A case is reported by Wormley, of a woman 
who swallowed by mistake for Epsom salt, an ounce and a 
half of this salt, and death ensued in thirteen hours and a 
half. 

Post-mortem appearances. — Decided evidences of inflam- 
mation in the mucous membrane of the alimentary canal, 
such as redness, softening, ecchymoses, and sometimes 
ulceration; a yellowish, pultaceous matter covering the 
inner surface of the stomach and bowels; congestion of the 
brain and membranes, also of the lungs, with bloody effusion 
into the pleura, and a distended, flabby heart. 

Chloride of zinc. — In strong solution, this is known as 
" Sir William Burnett's Disinfecting Fluid." It is much 
used as a deodorizer. It contains about two hundred grains 
of the salt to the ounce of water. It is a powerful corro- 
sive, and has frequently caused death when taken by mis- 
take or suicidally. 

The symptoms are, in general, the same as those produced 
by the sulphate, only much more intense in their character, 
and resembling somewhat those of the mineral acids. They 
come on immediately after swallowing ; the matters vomited 
and purged are frequently tinged with blood, and mixed 
with shreds of mucous membrane ; froth may issue from the 
mouth, and a white appearance of the inside of this cavity 
be noticed. There may also be loss of voice. 

Fatal period. — Dr. Taylor records the most rapidly fatal 
cdiSQ— four hours. On the other hand, the case may become 
chronic, lasting for years, and ending in stricture of the 
oesophagus and exhaustion. 

Post-mortem lesions. — In addition to the usual inflam- 
matory signs, those of a corrosive will be noticed, such as 
erosion or destruction of the coats of the stomach. Some- 
times these are hard and leathery, thickened and corrugated. 



ZINC TOXICOLOGICAL EXAMINATION. 303 

The pylorus has been found constricted, and appearing as if 
cauterized. Constriction of the oesophagus has also been 
noticed, together with a softened condition of its mucous 
membrane. The brain and lungs are congested ; the heart 
not affected, but usually distended. The blood dark and 
uncoagulated. 

Treatment. — Assist the evacuation of the poison by the 
free use of mucilaginous drinks. The best antidote is 
albumen, as in corrosive sublimate and copper-poison ing. 
Opium should be given, to combat the irritation. 

Chemical analysis. — In the solid state, the sulphate may be 
distinguished from Epsom salt and oxalic acid (which it 
much resembles in appearance), by exposing a small frag- 
ment mixed with carbonate of soda on a piece of charcoal, 
to the flame of the blowpipe; it quickly fuses, and the vapor 
forms an incrustation on the charcoal, which is first yellow, 
and becomes white on cooling. Heated with cobalt under 
the blowpipe, the fused bead of zinc has a green color. 

In solution, (i) The alkalies precipitate the white hydratcd 
oxide, which is soluble in excess of the precipitant. (2) The 
alkaline carbonates throw down the white carbonate, in- 
soluble in excess of the precipitant, but soluble in excess of 
carbonate of ammonia. (3) Ferrocyanide of potassium gives 
a white precipitate. (4) Sulphuretted hydrogen throws 
down the white sulphide, soluble in hydrochloric acid. This 
should always be verified by dissolving it in hot hydro- 
chloric acid, filtering, diluting and subjecting it to the other 
tests. (5) The galvanic test. — Place the solution on a 
platinum capsule, and touch it with a piece of magnesium, 
when the metal will be deposited on the platinum. 

Toxicological examinatio7t. — In a case of suspected poi- 
soning, it should always be remembered that sulphate of 
zinc may have been administered as an emetic ; hence, 



304 TOXICOLOGY. 

although discovered in the body after death, it may not have 
been the actual cause of death. If found, other poisons 
should also be sought for. The organic matters, along with 
a little acetic acid, should be gently heated for some time, in 
order to dissolve out the zinc that may have combined with 
albumen, fibrin, etc. After cooling, the solution should be 
filtered and concentrated, and then heated with sulphuretted 
hydrogen. The precipitated sulphide is collected on a 
filter, washed and dissolved in strong nitric acid. The 
nitrate is evaporated to dryness, dissolved in water, and 
subjected to the usual tests. 

As the preparations of zinc usually contain iron, the 
presence of the latter metal will more or less modify the 
reactions of the former. The iron may be separated by an 
excess of ammonia, which will precipitate the oxide of iron, 
whilst it retains the zinc oxide in solution. 

The tissues (liver, kidney, spleen, etc.) may be examined 
either by boiling with nitric acid, evaporating to dryness 
and adding small quantities of nitric acid, and heating until 
all the organic matter is destroyed ; or else by incinerating 
the perfectly dried viscera in a porcelain crucible, and treat- 
ing the resulting ash with nitric acid ; evaporating to dry- 
ness, and dissolving the residue in water; acidulate with 
hydrochloric acid ; again evaporate to dryness ; dilute with 
water, and apply the usual tests. 

Since chloride of zinc is often employed for embalming 
the dead, the discovery of zinc in the body after death might 
possibly be ascribed to this cause. 

Quantitative estimate. — Zinc is usually determined as an 
oxide. The boiling solution is precipitated with carbonate 
of soda. The precipitate is collected on a filter, washed and 
dried, and then ignited. The protoxide is then weighed. 
Every lOO grains represent 354.13 grains of pure crystallized 
sulphate, or i()y.yy grains of anhydrous chloride of zinc. 



POISONING BY BISMUTH. 305 

SECTION II. 
POISONING BY BISMUTH. 

Subnitrate of Bismuth — Magistery of Bisinuth — Pearl 
White. — This substance is considerably employed, both me- 
dicinally and as a cosmetic. As a medicine it is given in 
doses of five to thirty grains. Several fatal cases have been 
reported as resulting from large doses ; the symptoms being 
those of a violent irritant poison. Many authorities ascribe 
these results to the adulteration of the bismuth with arsenic. 
Dr. Taylor states that this adulteration is very common, and 
that he detected arsenic in comparatively large quantities in 
three out of five specimens obtained from respectable Lon- 
don druggists. The arsenic may readily be discovered by 
dissolving the subnitrate in pure hydrochloric acid, slightly 
diluted, and employing a Marsh's apparatus. This same 
adulteration has occasionally been found in the subnitrate of 
our own shops; and it should be looked to by physicians 
as being the probable cause of the irritation which occa- 
sionally follows the use of this medicine. 

This impurity may essentially modify a medico-legal 
opinion as to the presence of arsenic in a body, where bis- 
muth had been previously administered medicinally. A 
case of this nature (State of Virginia vs. Mrs. E. E. Lloyd, 
1872) occurred, in which the defence contended that the 
trace of arsenic alleged to have been discovered in the liver 
of the deceased was to be ascribed to the subnitrate of bis- 
muth which had been taken before death. This bismuth 
was found to be contaminated with arsenic. The prisoner 
was acquitted. 

By the process recommended by the present U. S. Phar- 
macopoeia, the bismuth is entirely freed from arsenic. 

Subnitrate of bismuth is in the form of a white powder, 
14* 



306 TOXICOLOGY. 

insoluble in water, but soluble in nitric acid. The solution, 
thrown into water, yields a copious white precipitate, which 
blackens by sulphide of ammonium, and is not soluble in 
tartaric acid. 

A delicate test for a bismuthic salt is a piece of paper 
wetted with a solution of sulphocyanide of potassium and 
dried ; a beautiful yellow spot appearing at the point of con- 
tact. It is stated that the urine will reveal the presence of 
bismuth, a few hours after taking the subnitrate, by means 
of this test. 

SECTION III. 
POISONING BY TIN, IRON AND CHROMIUM. 

Salts of Tin. — The only preparations of tin requiring no- 
tice are the chlorides. The effects of these salts upon the 
system are those of the metallic irritants ; but the instances 
of poisoning by them are rare. 

The protochloride is precipitated by sulphuretted hy- 
drogen of a dark chocolate color. Corrosive sublimate 
throws down the gray metallic mercury. Chloride of gold 
gives a fine purple precipitate — the pui'ple of Cassius. A 
fragment of zinc precipitates metallic tin, in an arborescent 
form. 

Bichloride of tin is precipitated yellow by sulphuretted 
hydrogen. This sulphide is distinguished from the yellow 
sulphide of arsenic by being insoluble in ammonia, and 
from sulphide of cadmium by being insoluble in hydro- 
chloric acid. Corrosive sublimate and chloride of gold 
yield no precipitate with it. 

The preparations of Silver^ Gold and Platijtum (with its 
allied metals) are all highly irritant and corrosive ; but they 
so rarely are the occasion of poisoning in the human sub- 
ject, that they need no further discussion here. 



POISONING BY CHROMIUM. 307 

Preparations of Iron. — The sulphate (green vitriol) is 
highly irritant in large doses, having proved fatal in several 
instances. Its action resembles that of sulphate of copper, 
though less violent. 

The chloride, in the form of tincture (muriated tincture 
of iron), is much used in medicine. In large doses it acts 
as a violent, corrosive poison. Christison records the case 
of a man who swallowed, by mistake, an ounce and a half 
of the liquid, and who died in about five weeks. It is oc- 
casionally used as an abortive. 

Preparations of Chromiiun. — The salts of chrome most 
used in the arts are the chromate and bichromate of potassium, 
and the chromate of lead. The two former are violent irri- 
tants in large doses ; sometimes acting, also, as corrosives 
to the lining membrane of the alimentary canal. 

Bichromate of potassium may be distinguished — (i) by 
its deep orange-red color; (2) by solution of acetate of lead, 
which precipitates the yellow bichromate of lead ; (3) by ni- 
trate of silver, which throws down a deep red precipitate ; 

(4) sulphuretted hydrogen gives a dingy-green sulphide ; 

(5) sulphuric acid added to a solution, along with alcohol, 
instantly throws down the green oxide, with effervescence ; 
yielding, at the same time, the odor of aldehyde. 



308 TOXICOLOGY. 



CHAPTER XXIII. 

VEGETABLE AND ANIMAL IRRITANTS. 

SECTION I.— POISONING BY OXALIC ACID. 

SOURCES OF THE ACID IN NATURE. — SYMPTOMS. — FATAL DOSE. — 
TREATMENT. — MORBID APPEARANCES. — CHEMICAL ANALYSIS. — 
TOXICOLOGICAL EXAMINATION. — BINOXALATE OF POTASSIUM. 

Oxalic Acid, in combination with lime and potash, exists 
naturally in certain plants, as the rhubarb, wood-sorrel, dock, 
etc. It is extensively used in the arts, under the name of 
acid of sugar. It is rarely employed for homicidal poi- 
soning, since it would be easily detected by its excessively 
sour taste ; but it is sometimes resorted to for suicidal pur- 
poses, and it has been frequently the cause of accidental 
death, from its being mistaken for sulphate of magnesia 
(Epsom salt), which it much resembles in appearance. 

Symptoms. — These depend very much on the size of the 
dose and the degree of concentration. In the quantity of 
half an ounce to an ounce, it acts as a prompt, violent, 
corrosive poison. In smaller doses and more diluted, its 
irritant effects may be much lessened, or altogether lost ; 
but its remote, specific operation on the heart and nerve 
centres is very observable in the acute pain in the back, ex- 
tending down the limbs, attended with tingling and numb- 
ness, and with tetanic spasms, together with occasional 
narcotism. On the heart, it acts as a decided depressant. 

When swallowed in a very large dose and dissolved in a 
small quantity of water, the effects are immediate. An 
intensely sour taste is followed by a burning sensation in 
the gullet, extending down to the stomach ; violent pain in 



POISONING BY OXALIC ACID. 309 

the abdomen, increased by pressure ; constriction of the 
throat ; vomiting of a greenish-brown or black matter, 
sometimes mixed with blood. If the patient lives, purging 
of a similar character sets in. The remaining symptoms 
are those of collapse, such as extreme debility, a cold, 
clammy skin, feeble, rapid pulse and hurried respiration. 
There are also soreness of the mouth, swelling of the 
tongue, intense thirst, restlessness and distressing cough ; 
also, frequently, cramps and numbness of the legs and arms, 
loss of voice, acute pain in the back and head, delirium and 
convulsions — symptoms that indicate the action of the poi- 
son on the nervous system. As in the case of other violent 
poisons, the above-mentioned symptoms are liable to many 
exceptions and anomalies ; thus, vomiting and pain may 
both be absent. 

There is every reason to believe that the poison is ab- 
sorbed into the blood, though hitherto experiments have 
failed to detect it in that fluid. Christison mentions a case 
where leeches, that had been applied to the epigastrium of a 
patient who had been poisoned by this acid, fell off dead, 
showing evidently that it had gotten into the circulation. 
The urine contains crystals of oxalate of lime in abundance, 
also albumen and tube-casts ; and according to some 
writers, deposits of similar crystals within the renal tubules. 

Fatal dose. — Half an ounce to an ounce is regarded as a 
fatal dose for an adult. Dr. Taylor quotes a case where 
one drachm of the solid crystals proved fatal to a boy six- 
teen years old, in eight hours. There are, however, cases 
on record where much larger doses have been swallowed 
without causing death. 

Fatal period. — In a large, concentrated dose, oxalic acid 
is one of the most energetic poisons known. Christison 
calls it " the most rapid and unerring of all the common 



310 TOXICOLOGY. 

poisons." Dr. Ogilvie reports the most rapidly fatal case 
known, where death occurred in three minutes after swallow- 
ing it (Lancet, Aug. 1 845). In other cases, death has 
followed in ten minutes ; the majority of cases prove fatal 
within one hour. Again, instances have occurred where the 
patient has survived for many hours, and even days. Dr. 
Beck alludes to the case of a woman who died from the 
secondary effects of the poison, after several months of 
suffering. 

Treatment. — This should be prompt, in order to be of any 
service. The best antidotes are chalk and magnesia, mixed 
up with milk. The alkalies and their carbonates are in- 
admissible, on account of their forming soluble poisonous 
compounds with the acid. The scrapings of a whitewashed 
wall should be resorted to in the absence of chalk and mag- 
nesia. Lime-water and oil are useful. Opium is indicated 
to relieve the severity of the symptoms. 

Post-mortem appearances. — The lining membrane of the 
mouth, throat and gullet will usually be found white, 
shriveled and easy of removal ; it may be covered over with 
the brown matters discharged from the stomach. The 
mucous membrane of the oesophagus may be entirely 
separated, displaying a surface of a brown color, and raised 
in longitudinal folds. The stomach, which is frequently 
contracted, contains an intensely acid, brown, gelatinous 
fluid ; the mucous membrane, if death has been rapid, may 
appear soft and pale, often without marks of decided inflam- 
mation ; but if death has been delayed, it is usually black 
in some places, and in others intensely congested and in 
rugae, with portions peeling off, revealing a gangrenous con- 
dition of the subjacent tissue. Such cases strongly resemble 
those of sulphuric acid poisoning. Perforation of the 
stomach is rare. 



OXALIC ACID CHEMICAL ANALYSIS. 311 

The intestines are usually highly congested, if death has 
been at all delayed. The lungs generally, and the brain 
occasionally, have been found congested. The heart is 
sometimes quite empty, and at others, distended with dark 
blood. The blood throughout the body is fluid. A few 
cases have occurred where all morbid appearances have been 
absent. 

Chemical analysis. — (i) As a solid. When pure, it occurs 
in colorless four-sided crystals, of an intensely sour taste 
(by which it is immediately distinguished from sulphate of 
magnesium), being soluble in water, especially hot ; soluble, 
also, in alcohol, but insoluble in ether, and nearly so in 
chloroform. It is completely volatilized by heat, leaving no 
residue; this is not the case with the sulphates of magnesium 
and zinc, for which it has been mistaken. 

(2) As a liquid. — It reddens litmus paper; a drop 
evaporated to dryness leaves long, slender prisms, {a) 
Nitrate of silver gives a copious white precipitate of oxalate 
of silver, distinguished from the chloride and cyanide by 
being soluble in cold nitric acid. If the precipitate is thor- 
oughly dried and heated on platinum foil, it is completely 
dissipated in a white vapor, in a succession of puffs or slight 
detonations, {p) Sidphate of calcium {or any lime salt) gives 
a white precipitate of oxalate of calcium, which is distin- 
guished from the carbonate and phosphate by being insoluble 
in acetic acid, but being soluble in nitric, and rather less so 
in hydrochloric acid. Sulphate of calcium will also pre- 
cipitate solutions of barium, strontium and lead; but the 
sulphates of these bases are insoluble in nitric acid, if) 
Chloride of barium, nitrate of strontium and acetate of lead 
all precipitate the white crystalline oxalates of these bases, 
which are soluble in nitric and hydrochloric acids ; but these 
tests are of inferior value to the former ones, {d) Sulphate 



312 TOXICOLOGY. 

of copper yields a faint bluish-white oxalate of copper, 
which is almost insoluble in nitric acid. 

Toxicological examination. — If the contents of the stomach 
are highly acid, the poison may probably be separated by 
dialysis, or they may be digested with distilled water, at 
a moderate heat, for some hours, and then filtered, the 
filtrate concentrated, and tested with sulphate of copper. 
If this test affords evidence of the presence of oxalic acid, 
the liquid may be evaporated to crystallization, and the 
crystals thus obtained re-dissolved in pure alcohol, and the 
solution again crystallized. 

But it is usually recommended to treat the first filtrate 
with an excess of solution of acetate of lead ; wash the 
precipitated oxalate of lead on the filter; then diffuse it 
thoroughly in pure water and pass through it a current of 
washed sulphuretted hydrogen, until all the lead and organic 
matter is thrown down. Heat a little while, to expel the 
excess of sulphuretted hydrogen, then filter, and crystallize 
the filtrate by evaporation. Purify the crystals, if necessary, 
by re-solution, and apply the usual tests. 

But it may happen that all the oxalic acid in the stomach 
has been neutralized by the antidotes that were adminis- 
tered — lime or magnesia, in which case the contents of the 
stomach would not be acid. Here the inspected solids 
should be collected, and thoroughly washed with warm 
water, and the liquid decanted off; if this liquid is acid, it 
should be reserved for examination ; if not acid, it may be 
thrown away. The solids should then be diffused in pure 
water, and boiled for some time with pure carbonate of 
potassium, which decomposes the oxalates, forming soluble 
oxalate of potassium and insoluble carbonate of lime and 
magnesia. These are separated by filtration, and the solution 
concentrated by gentle heat, until the crystals are formed. 



OXALIC ACID DETECTION. 313 

In a case of alleged oxalic acid poisoning, it might be 
objected that the presence of a minute quantity of oxalic 
acid found in the stomach after death might be due to rhu- 
barb or sorrel that had been eaten by the deceased. The 
answer to this is obvious: if there is an entire absence of all 
the characteristic symptoms of this active poison, the dis- 
covery of a small quantity of the acid is certainly no evi- 
dence of poisoning ; but on the other hand, if the peculiar 
symptoms of this poison, and morbid lesions are present, 
then the obtaining of only a small amount of the acid 
should not negative the charge of poisoning. 

In a case of suspected poisoning by oxalic acid, the urine 
should always be examined for an increase of the octahe- 
dral crystals of oxalate of lime. This fluid should be col- 
lected in a conical glass, and the sediment which collects 
after some time should be examined with the microscope. 
But all the lime-oxalates may not be thus precipitated ; a 
portion may be held in solution by the acid phosphate of 
sodium which exists in the urine. 

It should, however, be remembered that these same 
crystals may be found in the urine of persons who have 
partaken of food containing oxalic acid, such as rhubarb 
and sorrel. 

To detect free oxalic acid or a soluble oxalate in the 
urine, add a little acetic acid and concentrate to about one- 
fourth its bulk, then add acetate of lead in excess, filter ; 
decompose the oxalate of lead with sulphuretted hydrogen, 
and treat the filtered solution as above directed. 

Stains of this acid on cloth, parchment, paper, etc., may 
be discovered by boiling them in water, and applying the 
usual tests. The color of these stains on black cloth is 
orange, and brownish-red. This acid is sometimes employed 
to remove writing-ink, in cases of forgery ; but usually there 



314 TOXICOLOGY. 

are left on the paper traces of iron, existing in the ink, which 
can readily be recognized by applying a solution of the fer- 
rocyanide of potassium, which will turn it blue. 

Oxalic acid is usually estimated quantitatively as oxalate 
of lead; every lOO parts of the dried pure oxalate are 
equivalent to 42.5 of the crystallized acid. 

Oxalic acid is not a normal constituent of the human 
body; although supposed by Liebig and others to be one 
of the ultimate results of the oxidation of uric acid in the 
economy, yet no one has been able to demonstrate its 
existence in the blood. In disease it is frequently found in 
the tissue in the form of oxalate of Ihne^ in which form also 
it constitutes the variety of calculus named the mulberry 
calculus. 

Binoxalate of Potassiiun — {Salt of Sorrel — Essential Salt 
of Lemons). — This salt is much used in the arts for bleach- 
ing, etc. It is almost as active a poison as oxalic acid. The 
symptoms, dose and lesions are very similar to those of the 
acid. It is distinguished from the latter, (i) by heating a 
fragment on platinum foil; an ash is left (carbonate of po- 
tassium), while the acid is entirely dissipated ; (2) it crys- 
tallizes in feathery forms ; (3) it is distinguished from cream 
of tartar by lime water, which precipitates both, but the 
tartrate of calcium is immediately re-dissolved by tartaric 
acid, while the oxalate is insoluble. This salt is a natural 
ingredient in the sorrel. 

Tartaric and acetic acids act as powerful irritant poisons 
in the concentrated state and in large doses. They have 
both produced fatal results when taken in doses of an 
ounce. Their proper antidotes are the alkaline carbonates, 
and chalk or magnesia. 



POISONING BY CARBOLIC ACID. 315 

SECTION II. 
POISONING BY CARBOLIC ACID. 

Carbolic Acid — (Phenic Acid — Plienol) — is one of the 
products of the distillation of coal tar. When pure it is in 
the form of white acicular crystals, which, when exposed 
for some time to the light, acquire a reddish tinge. They 
have a strong affinity for water, and liquefy when exposed 
to the air. It is not, however, very soluble in water; much 
more so in alcohol, ether and glycerine. It has a burning 
taste, and a peculiar, strong, creasote odor. It is sometimes 
named coal-tar creasote. It is powerfully antiseptic, quickly 
destroying the germs of the lower forms of organic life. 
Applied in its undiluted state to the skin, it acts as a cor- 
rosive and anaesthetic, corrugating and hardening it. Taken 
internally, undiluted, its effects are those of an energetic, 
corrosive and neurotic poison. 

Symptoms. — Intense burning pain in the mouth, throat 
and stomach; the pupils are contracted; the conjunctiva 
insensible to the touch ; marked odor of the acid exhaled 
from the breath ; the skin cold and clammy ; the tempera- 
ture rapidly falls ; the pulse becomes weaker and weaker, 
but fluctuates in its beats ; respiration is labored and ulti- 
mately stertorous ; vomiting of a frothy mucus sometimes 
occurs ; the mouth is white, and hardened, from the local 
effects of the acid. Coma usually precedes death, which 
may also sometimes be accompanied by convulsions. Death 
may occur within an hour from swallowing the poison ; in 
one case, within ten minutes. The urine, as shown by 
Stevenson, is often of an olive-green color. 

Many of the above symptoms have been produced by. 
the external application of the acid, especially to denuded 
surfaces. 



316 TOXICOLOGY. 

Fatal dose. — Dangerous symptoms have occurred from 
doses of six or seven drops. The deaths recorded have 
resulted from doses of one to two ounces ; but much less 
quantity would certainly prove fatal. 

Treatment. — Assist the evacuation of the poison by 
emetics of mustard water, and sulphate of zinc, albumen, 
oil and demulcents. Sulphate of soda is regarded by some 
as a true antidote. Dr. Husemann considers the saccharate 
of Ihne an antidote. Oil is the best outward application to 
the skin. Stimulants must be freely given, to combat the 
collapse. 

Post-mortem lesions. — The mouth and oesophagus are 
usually white, soft and corroded, but sometimes har- 
dened and corrugated. The brain is generally normal, but 
occasionally congested, and the fluid in the ventricles exhal- 
ing the strong odor of the acid. The lungs are usually 
gorged with blood. The left ventricle of the heart is 
generally contracted, while the right is flaccid. The blood 
is uniformly dark colored and fluid. The odor of car- 
bolic acid is detected in the stomach, sometimes in the 
intestines, and even in the other viscera. The mucous lin- 
ing of the stomach has been found white, hardened and 
wrinkled ; but, again, highly congested and corroded. The 
bladder is usually empty, any urine passed being of a dark, 
or olive-green color. 

Chemical analysis. — The odor is probably the best test. 
It has a slight acid reaction, and forms salts with bases. It 
imparts a transient, greasy stain to paper. It coagulates 
albumen. It gives a deep violet color to perchloride of 
iron, and a bluish tint to ammonia and hypochlorite of lime; 
if this be acidulated, it turns red. Bromine water causes a 
whitish-yellow flocculent precipitate ; if this be treated with 
sodium-amalgam, carbolic acid is set free (Landolt), Heated 



POISONING BY CROTON OIL. 317 

with cyanide of potassium, it gives a red tint. A splinter 
of wood, moistened with the acid, and afterward dipped into 
nitric or hydrochloric acid, turns of a greenish-blue tint 
when dry (Woodman and Tidy), 

Toxicological examination. — Generally, the characteristic 
odor of the acid will be perceived in the body after death. 
The organic matters should be distilled along with dilute 
sulphuric acid. 

Carbolic acid can generally be detected in the urine, both 
by the odor and by chemical reagents. The urine may 
either be distilled without sulphuric acid (as it is said this 
acid may develop carbolic acid from some of the normal 
constituents of the urine) ; or by agitating it with an excess 
of ether, and subsequently removing the ethereal layer by 
means of a pipette, and evaporating in a shallow dish ; a 
minute oily residue is left, having the character of carbolic 
acid. 

SECTION III. 

POISONING BY CROTON OIL, ELATERIUM, CASTOR-OIL BEANS, 
COLCHICUM, AND SAVIN. 

Croton oil is a fixed oil, extracted by pressure from the 
seeds of Croton tiglium. It is used in medicine as a powerful 
purgative, in doses of one or two drops. In over-doses, it acts 
as a violent irritant to the gastro-intestinal mucous mem- 
brane, causes excessive vomiting and purging, followed by 
collapse, as in cholera. Its poisonous properties seem to be 
dependent on a peculiar fatty acid named crotonic, which 
exists in the oil in variable quantities. When deprived of 
this acid the oil is harmless. 

Croton oil is of a light yellow color, has an unpleasant 
odor, and a hot, acrid, burning taste. It is very soluble in 
ether. Nitric acid, with the aid of heat, imparts to it a dark 
brown color. 



318 TOXICOLOGY. 

Death has resulted in one case from taking, by mistake, 
an embrocation containing thirty minims of the oil. In 
another case, two and a half drachms proved fatal in four 
hours; whilst in a third instance, half an ounce of croton oil 
was taken by mistake, and after exciting violent vomiting 
and purging, with symptoms of collapse, the patient re- 
covered, after fourteen days. 

Analysis. — Separate the oil from the contents of the 
stomach by means of ether, and evaporate the ethereal solu- 
tion spontaneously, and test the resulting oil with nitric 
acid and heat. 

Elateriuni. — This substance is procured from the juice of 
Ecbalium officinarum, or squirting or wild cucumber. It is 
used in medicine as a powerful drastic purgative. Its effects 
are very similar to those of croton oil. One grain of good 
elaterium has produced very violent effects. It owes its 
activity to a neutral resinous principle, elaterin. Nitric 
acid has no action upon it. Sulphuric acid turns it of a 
reddish-brown color. 

Castor Oil Beans are derived from the Ricinus communis^ 
and yield by pressure the castor oil of commerce. The 
seeds contain an irritant, poisonous principle, which causes 
them to act violently when swallowed. They have occa- 
sionally proved fatal. In one case three seeds destroyed 
life in an adult male in forty-six hours, and twenty seeds 
proved fatal to a young lady in five days, after violent 
symptoms, strongly resembling those of malignant cholera. 

Colchicum. — The Colchicum autumnale, or meadow saffron, 
contains a powerful alkaloidal principle, colchicina^ which 
strongly resembles veratria in many of its properties. It 



POISONING BY COLCHICUM. 319 

abounds chiefly in the bulb of the plant, but is also found in 
the seeds. 

The effects of a large dose upon the system are those of a 
violent irritant, such as burning pain in the throat and 
stomach, great thirst, vomiting and soreness, purging, 
cramps, cold, collapsed skin, feeble pulse, dilated pupils, 
suppression of urine, and rapid exhaustion. Sometimes 
there are delirium and convulsions. 

The strength of the preparations of colchicum varies 
greatly, depending upon the time of gathering the plant, and 
also its place of growth. 

Death has resulted in seven hours, and again has been 
delayed for several days. Generally, it occurs within 
twenty-four hours. Less than half an ounce of the wine of 
the root, forty-eight grains of the dried bulb, and a table- 
spoonful of the seeds have severally proved fatal. A fright- 
ful accident occurred in Montreal, Canada, in 1873, to a 
company of eight or nine persons. They had freely par- 
taken of what they supposed to be ordinary wine, but 
which was really wine of colchicum. In the course of a 
few iiours they became alarmingly ill, with nausea, vomit- 
ing, excruciating pains, purging, cramps and prostration. 
Five of the cases terminated fatally within thirty-six hours. 

Morbid appearances. — These consist of inflammation of 
the stomach and bowels. In some instances, no morbid 
appearances exist. In one case, the pia mater was much 
congested, when there was an absence of inflammation from 
the stomach. The lungs are usually deeply congested. 

Colchicina occurs in fine, white crystals. It is soluble in 
water, has a feeble, alkaline reaction, and a bitter, acrid taste. 
Its best test is nitric acid, which gives it a violet color, 
changing to blue and brown. It differs from veratria in its 
negative action with sulphuric acid. It may be recovered 



320 TOXICOLOGY. 

from organic mixtures by a modification of Staas' process 
(vid. post) Less than half a grain of colchlcina has 
proved fatal. There Is no known antidote to It. 

Savin. — The tops of the Juniperus sabina contain a vola- 
tile yellow oil (oil of saviit), which may be procured by dis- 
tillation. Both powder and oil are employed in medicine, 
and both possess powerfully irritant properties. They are 
seldom or never used as poisons, but they frequently produce 
fatal results when used as abortives. Although they do not 
possess specific ecbolic properties, uterine contractions may 
follow their powerful Irritant effects upon the pelvic viscera; 
but death is a more frequent result, without the expulsion of 
the foetus. 

In cases of poisoning by the powder, this may often be 
discovered in the stomach and bowels, by microscopic in- 
spection. The oil maybe separated by distillation from the 
contents of the stomach, and then agitating the distillate 
with ether, in which It Is soluble, and allowing the solution 
to evaporate. It Is recognized by Its peculiar terebinthinate 
odor. 

SECTION IV. 

POISONING BY THE HELLEBORES. 

VERATRIA — YELLOW JESSAMINE — POISONOUS MUSHROOMS. 

Black Hellebore — [Helleborus niger) — formerly named 
Melainpoditi7n, is sometimes employed In medicine. It Is a 
powerful Irritant to the stomach and bowels, and has proved 
fatal In overdoses, occasioning violent vomiting, purging, 
abdominal pain, cold sweats, collapse and convulsions. 

Gree7i Hellebore ( Veratrum viride — American Hellebore — 
Indian Poke). — This species possesses very active properties, 
and has occasioned fatal results. The tijtcture is used in 
medicine as a powerful cardiac depressant. Two active 



VERATRIA TESTS. 32 I 

alkaloidal principles exist in this drug — veratroidia and 
viridia — which, though resembling veratria in some points, 
are distinct from it. 

White Hellebore ( Veratrum albmit). — This is the most poi- 
sonous of all the hellebores. The powder produces violent 
sneezing. Taken internally, it causes a sense of burning 
heat and constriction of the throat, great anxiety, nausea, 
vomiting and purging, pain of the abdomen, trembling of 
the limbs, great prostration, cold sweats, very feeble pulse, 
giddiness, convulsions, insensibility and death. Death has 
occurred in three and six hours after taking it. 

The active principle is Veratria, which also exists in the 
Veratrum sabadilla. 

Veratria. — As found in the shops, this alkaloid is in the 
form of a white powder. It may be crystallized with diffi- 
culty. It has an acrid, bitter taste, followed by a sense of 
dryness in the throat. It is a violent irritant to the nostrils, 
causing excessive sneezing. It is insoluble in water, soluble 
in alcohol, ether, chloroform, benzole and amylic alcohol. 
Heated on porcelain, it melts and blackens, evolving a pun- 
gent vapor. 

Effects. — Dr. Taylor (On Poisons, p. 510) mentions the 
case of a lady on whom the tV of a grain occasioned most 
alarming symptoms, such as insensibility, cold sweats, fail- 
ing pulse and collapse. It acts as a local irritant to the 
stomach and bowels, and at the same time as a general de- 
pressant. 

Chemical analysis. — The characteristic test is sulphuric 
acid. A drop applied to the pure alkaloid imparts a yellow 
color to it, followed by a reddish tint, which gradually passes 
to a deep crimson. This change is brought about imme- 
diately by heat. Even a very dilute acid causes this re- 
action, by evaporating to dryness. (See Sulphuric Acid, 
15 



322 TOXICOLOGY. 

ante?^ According to Wormley, the too-q^ of a grain of ve- 
ratria may be thus detected. 

Other substances give a red color to sulphuric acid — such 
as solanine, narceine, salicme, piperine, etc., but these are 
ivnnediately colored by cold sulphuric acid, whereas veratria 
requires the lapse of some time before this change is 
effected. 

Trapfs test consists in warming the colorless solution of 
veratria in concentrated hydrochloric acid, when a persistent 
dark red color results. 

In organic mixtures^ veratria may be separated by a modi- 
fication of Stass' process, and the ultimate chloroform extract 
tested by sulphuric acid. Dr. Wormley states that by this 
test he was enabled to recognize the presence of veratria in 
an ounce of blood of a cat which had been killed, in less 
than one minute, by two grains of veratria. 

Yellow Jessamine {Gelsemium sempervirens). — The root 
of this plant is considerably employed in medicine, especially 
in the Southern States of our country, in the treatment of 
neuralgia, and analogous complaints. It has frequently 
produced fatal results, the symptoms somewhat resembling 
those produced by veratria. Wormley found it to contain 
a powerful alkaloidal principle — gelseniia, one-eighth of a 
grain of which killed a rabbit in an hour and a half, together 
with another organic principle — gelseminic acid. The above 
authority succeeded in detecting both of these principles in 
the stomach of a woman who was poisoned by three tea- 
spoonfuls of the extract, several months after death (Am. 
Jour. Med. ScL, April, 1870). 

Poisonous Mushrooms. — As is well known, certain varie- 
ties of fungi are edible, while others possess noxious, and 



POISONOUS MUSHROOMS. 323 

even fatal properties. It is not always possible to distin- 
guish between these, inasmuch as climate, season, and 
idiosyncracy may occasion the difference. The poisonous 
principle of certain fungi appears to be volatile, since boiling 
renders them innocuous. 

Symptoms. — The effects of poisonous mushrooms on man 
are those of the narcotic irritants, causing violent vomiting, 
purging, abdominal pain, thirst, anxiety, cold sweats, 
together with giddiness, dimness of vision, trembling, 
dilated pupils, delirium, illusions, stupor, coma, convulsions 
and death. 

It is stated that the very same fungi have acted on some 
members of a family as vomitants only, and on others as 
narcotics. 

Generally, the symptoms show themselves within one 
hour — especially the narcotic symptoms. Orfila (Toxicol. 
II, p. 433) relates the following interesting case of poisoning 
of a family of six persons by the Amanita citrina. The 
wife, servant and one of the children had vomiting, followed 
by deep stupor, but they recovered. The husband had 
violent cholera ; he recovered also. The two other children 
became profoundly lethargic and comatose ; emetics had no 
effect, and death ensued. The individuals who recovered 
were not completely well until three weeks after the fatal 
repast. 

Morbid appearances. — These are imperfectly described; 
they indicate a great tendency to rapid putrefaction, lividity 
of the body, fluidity of the blood, absence of cadaveric 
rigidity, numerous ecchymoses in the serous membranes 
and parenchymatous organs, signs of violent and even 
gangrenous inflammation of the stomach, and congestion 
of the vessels of the brain, with decomposition of the 
tissues. 



324 TOXICOLOGY. 

The chief medico-legal interest connected with this sub- 
ject is the fact that the symptoms occasioned by eating poi- 
sonous fungi might easily be attributed to poisoning — 
homicidal, or otherwise. A microscopic examination of the 
contents of the stomach and bowels will usually reveal the 
botanical character of the fragments of the fungi, if the poi- 
soning has been due to them. (See Orfila and Christison 
on the subject of Poisonous Ftingi) 



POISONING BY CANTHARIDES — SYMPTOMS. 325 



CHAPTER XXIV. 

ANIMAL IRRITANTS. 

POISONING BY CANTHARIDES. — POISONOUS ANIMAL FOOD. — SAUSAGE 
POISON. — TRICHINOSIS. — CHEESE POISON. — POISONOUS FISH. — 
PUTRESCENT FOOD. — POISONED FLESH. 

CANTHARIDES. — The Canthavis vesicatoria, or Spanish fly, 
is much used in medicine, both externally as a vesicant, and 
also internally. In large doses it acts as a powerful local 
irritant to the alimentary canal, and also to the urino- 
genital organs. It is often used as an abortive, and has not 
unfrequently produced fatal effects when employed for this 
purpose. It owes its active properties to a crystalline prin- 
ciple named caniharidin, which exists in the proportion of 
about one grain to half an ounce of the powder. 

Symptoms. — A burning sensation in the mouth and throat, 
with constriction and difficulty of swallowing ; violent pain 
in the abdomen, increased by pressure ; nausea and vomit- 
ing of a bloody mucus and shreds of membrane, along with 
great thirst, and dryness of the fauces. Soon the charac- 
teristic impression on the genito-urinary organs displays 
itself, in a dull, heavy pain in the loins, an urgent and inces- 
sant desire to urinate, which is attended with great pain and 
the voiding of merely a few drops of bloody urine, accom- 
panied with tenesmus. Priapism frequently occurs in males, 
and swelling and heat of the labia in w^omen, together with 
abortion, at times, in pregnant females. Purging generally 
supervenes, the stools being bloody and mucous, and accom- 
panied with tenesmus. Sometimes there is profuse saliva- 
tion, and in fatal cases faintness, giddiness, and convulsions. 



3z6 TOXICOLOGY. 

If the substance has been taken in the form of powder, the 
characteristic shining green particles may generally be 
recognized in the discharges from the stomach and bowels. 
If the tincture has been taken, the above symptoms come on 
more rapidly. 

All the above symptoms have been produced by the ex- 
ternal application of cantharides. 

Fatal dose. — Twenty-four grains of the powder, and an 
ounce of the tincture, have caused death. 

Treatment. — Speedy evacuation by emetics and cathartics 
(castor oil) ; opium and stimulants. 

Post-mortem appearances. — Intense inflammation of the 
mucous membrane of the alimentary canal, from the mouth 
downward; also of the ureters, kidneys and bladder. Con- 
gestion of the brain has been observed. The peculiar shin- 
ing green particles can generally be distinguished in the 
stomach and bowels. But if the tincture has been swallowed 
it will be necessary to procure the extraction oi cantJiaridin 
from the organic matters. 

Chemical analysis. — The suspected materials should be 
dried, and digested in successive portions of ether, until ex- 
hausted ; this will dissolve out the cantharidin. The ethereal 
solution is to be evaporated until nearly dry, and the residue 
should be spread on oiled silk, and a portion applied to the 
lips, or on the thin portion of the skin of the arm, when the 
resulting vesication would denote the presence of can- 
tharides. 

Poisonous animal food. — It occasionally happens that 
various kinds of animal food, such as sausages, cheese, 
fish, mussels, etc., produce poisonous symptoms, either ow- 
ing to some idiosyncrasy on the part of those who have 
partaken of them, or depending upon some noxious agent 



SAUSAGE AND CHEESE POISONING. 327 

connected with the food itself, either introduced from with- 
out, or spontaneously generated within. 

Such cases are often attended with symptoms of a violent 
character, which naturally suggest poisoning, and they then 
become the subjects of medico-legal examination (z//^./^^/., 
Ptomaines). 

Sausage poison. — It was formerly supposed that, under 
certain peculiar circumstances, not well understood, sausages 
when cured and dried were capable of developing a poison- 
ous principle, in the shape of a peculiar fatty acid, named 
by Bushner batrolinic acid. But physicians and physiolo- 
gists of the present day are disposed to attribute the cause 
of the so-called sausage-poison to the presence of an ento- 
zoon, named Trichina spiralis^ which especially infests the 
muscles of the hog, and which, when, the pork is eaten 
uncooked, and unless it has been exposed for some time to 
a temperature above 212° F., very soon penetrates the mus- 
cular coat of the intestines, and thence spreads rapidly 
through the muscles generally, and which Increase in 
numbers prodigiously. The sudden liberation of a multi- 
tude of these parasites from their cysts, in the intestines and 
muscles, produces the irritation of the bowels, and the sub- 
sequent loss of muscular power that are so characteristic 
of trichinosis. 

It may readily happen that the symptoms thus occasioned 
might be attributed to slow poisoning by one of the mineral 
irritants. A careful microscopic examination of the sus- 
pected food, or of a fragment of a muscle of either a living 
or dead subject, will reveal the true source of the disorder. 

The symptoms of Cheese poisoning are very similar to 
those of ordinary irritant poisoning. The cause of the 



328 TOXICOLOGY. 

development of poisonous properties in cheese is by no 
means well understood. By some it is ascribed to the pro- 
duction of an acrid, oily matter derived from an improper 
fermentation of the milk, analogous to caseic and sebacic 
acid. Instances of cheese poisoning are more common in 
Germany than in this country. 

Poisonous fish. — In certain individuals, probably through 
idiosyncrasy, many kinds of fish act poisonously, i. e., they 
excite severe gastro-intestinal symptoms, resembling cholera 
morbus. It is quite possible that some peculiar organic 
change in the food itself may have taken place. Mussels^ 
which are quite extensively used in Europe as food, occa- 
sionally produce most violent and alarming symptoms, 
which cannot be ascribed to any rational cause. 

These symptoms are not of a uniform character. Some- 
times they are those of a simple irritant, such as nausea, 
vomiting, purging, pain in the abdomen, cramps, small and 
frequent pulse. The fatal cases disclose, on post-mortem 
examination, evident signs of inflammation. In other 
instances, the gastro-enteric disturbance has been slight, 
whilst the nervous symptoms are well marked, such as 
delirium, insensibility and coma, with dyspnoea and convul- 
sions. Again, the most conspicuous symptoms have been 
a peculiar eruption resembling urticaria, along with severe 
asthma. The symptoms usually do not appear until the lapse 
of twenty-four hours, but there are cases where they come on 
very much earlier. In fatal cases, the autopsy usually reveals 
nothing that will satisfactorily account for the result. 

No rational, adequate cause of this singular poisonous 
action of the shell fish has yet been discovered. We must, 
therefore, ascribe it to some peculiar animal principle 
generated under unknown conditions. 



PUTRESCENT AND POISONED MEAT. 329 

Putrescent or decayed meat, if eaten by man, will produce 
not only gastro-enteric symptoms similar to those described 
above, but also those of a typhoid character, or septicmmia^ 
or true blood poisoning. The game that has been kept long 
enough to delight the taste of the epicure has produced a 
severe cholera in persons not accustomed to its use. 

Putrid animal matter injected into the blood vessels 
proves quickly fatal. Dissecting wounds thus may pro- 
duce alarming symptoms, which may terminate in death. 

Poisoned meat. — The flesh of an animal or bird which has 
become poisoned by arsenic, strychnine, or some other 
deleterious substance, may become the cause of poisoning 
to man. Thus, the common pheasant of this country 
(Tetrao umbelLus) which has fed upon the leaves and buds of 
the kalmia (laurel^, has proved poisonous to persons who 
have eaten the birds. It is well known that the milk of 
cows and goats that have fed upon the Datura stranioniiun 
may prove poisonous to those partaking of it. In one case 
of alleged poisoning by belladonna, the defence was that 
the family had eaten a rabbit pie, and that the animal had 
fed upon the leaves of the belladonna plant, so that, without 
being affected injuriously itself, it had conveyed the poison 
to those who had partaken of it. 



15* 



330 TOXICOLOGY 



CHAPTER XXV. 

CLASS IL— NEUROTIC POISONS. 

This second division of Poisons embraces those whose 
effects are displayed chiefly on the great nervous centres — 
the brain and spinal marrow. Their symptoms are drowsi- 
ness, headache, giddiness, stupor, delirium, convulsions and 
paralysis. They produce little or no irritation, or inflam- 
mation on the mucous membrane of the alimentary canal. 
Their morbid effects are not very distinctly marked. These 
consist of more or less fullness of the cerebral vessels, rarely 
effusion of serum; more rarely still, effusion of blood in the 
brain. Hence, it is quite impossible to diagnose a case of 
neurotic poisoning by these lesions exclusively. 

ORDER I.— CEREBRAL NEUROTICS.— (i) NARCOTICS. 

SECTION I.— POISONING BY OPIUM. 

NATURE OF OPIUM. — POISONOUS SYMPTOMS. — FATAL PERIOD. — FATAL 

DOSE. — TREATMENT. MORPHIA. — PROPERTIES. — TESTS- — MECONIC 

ACID. — TESTS. — TOXICOLOGICAL EXAMINATION IN OPIUM POISONING. 

Opium and its preparations constitute a very large pro- 
portion of poisoning cases, both in this country and Great 
Britain. 

Opium is the dried juice of the capsules of the poppy 
{Papaver somniferum). It has a very complex composition, 
containing numerous active principles, the chief of which 
are morphia, meconic acid, narcotina, codeia, narceiiie, thebaine 
and papaverine. In a medico-legal view, the only important 
ones are morphia and meconic acid, since, in an analysis for 



POISONING BY OPIUM SYMPTOMS. 331 

the detection of opium in a case of suspected poisoning, the 
investigation is narrowed down to the discovery and identi- 
fication of these two substances. 

It should be remembered that different specimens of opium 
differ considerably in their contained amount of morphia, 
this varying from two to thirteen per cent. The average 
may be taken at eight per cent, in Smyrna opium. The 
tincture (laudanum) of the shops is far from being of a uni- 
form strength, owing to this variation in the amount of the 
active principle in the opium, and also to fraudulent dilution. 
Average laudanum should contain about five grains of opium 
to the fluid drachm, which is equivalent to one grain to 
twenty-five drops. The black drop {Acetum Opii) is about 
double the strength of laudanum. Wine of opium {Syden- 
ham's laudanum) is about the strength of laudanum. 

Symptoms. — These vary according to the size of the dose. 
A large, but not fatal dose occasions, at first, general excite- 
ment of the system, as evinced by increased fullness and 
frequency of the pulse, flushed face, brilliancy of the eyes, 
and increased activity of the brain. This is soon followed 
by calm repose, which in turn gives place to profound sleep. 
In proportion as the amount of opium is increased, the first 
period of excitement is shortened, the more characteristic 
soporific effects manifesting themselves sooner. In such a 
case there will be giddiness and drowsiness, rapidly passing 
into profound sleep or stupor, from which it will be difficult 
to arouse the patient ; this stupor gradually ends in coma. 
The pupils are contracted. At first the pulse is full and 
slow; subsequently it becomes weak. The respiration is 
generally slow and stertorous ; the skin warm, and the face 
flushed. As the case advances, the countenance becomes 
pale, the lips livid, the skin cold and clammy, the respiration 
very slow — we have noticed it reduced down to five or six 



332 TOXICOLOGY. 

in a minute; the muscles are relaxed; convulsions some- 
times occur just before death, but these are more common 
in children than in adults. Sometimes there is vomiting, 
which is to be regarded as a hopeful sign ; and occasionally 
also there may be purging. At times, the skin is bathed in 
a profuse perspiration. 

Certain variations in the above symptoms should be 
noticed. The pupils are usually strongly contracted ; 
towards the termination of the case they may sometimes 
be dilated. Occasionally one pupil may be contracted, and 
the other dilated. The contracted state of the pupils is 
usually regarded as a diagnostic sign of opium-poisoning, 
but Dr. Wilks has shown that this same condition of the 
eyes occurs in apoplexy of the pons varolii, and that two 
cases of this latter disease were mistaken for opium-poison- 
ing (Med. Times and Gaz., 1863, I, p. 214). The same con- 
traction of the pupil occurs also in ursemic poisoning, in the 
course of Bright's disease. 

First appearance of symptoms. — This will depend on the 
size of the dose, the form of administration, and the condi- 
tion of the stomach at the time. As a rule, the symptoms 
usually commence within an hour after swallowing the 
poison. But, if taken in the liquid form and in full quan- 
tity, they may manifest themselves in a few minutes. We 
have often seen full narcosis produced in five to ten minutes 
by the subcutaneous injection of a quarter of a grain of 
morphia. On the other hand, cases are reported where the 
symptoms were delayed, even after swallowing very large 
doses, for many hours. Sometimes a partial remission of 
the symptoms occurs, and the patient gives hopes of 
recovery; but they return again only to terminate in death. 
There seems good reason to believe that alcohol tends to 
postpone the development of the usual symptoms of opium. 



POISONING BY OPIUM EXTERNAL APPLICATION. 333 

Fatal period. — The average duration of a fatal case is 
from seven to twelve hours. Cases are reported where the 
symptoms appeared in thirty-five minutes, and death in 
three-quarters of an hour ; whilst, on the other hand, death 
has been, in some instances, delayed for twenty-four to forty- 
eight hours. 

Fatal dose. — Four or five grains may be regarded as the 
minimum fatal dose for an adult. Children are particularly 
susceptible to the action of this drug; in very young infants, 
fatal effects have resulted from taking two or three drops of 
laudanum. An infant may be narcotized by the milk of a 
nurse who has taken opium. 

On the other hand, recoveries constantly take place from 
very large doses — even up to several ounces. It is noto- 
rious that the human system, soon acquires a remarkable 
tolerance for this narcotic by habit. De Quincey thus 
brought himself to the daily use of nine ounces of lauda- 
num, which is equivalent to dhoui three hundred a7id sixty 
grains of solid opium. 

Occasional instances of idiosyncrasy occur, in which the 
susceptibility to the narcotic influence of opium is greatly 
augmented; and also, pn the other hand, where there seems 
to be a natural tolerance for the drug. As regards the 
opiitni habit, we think there can be no doubt of its ultimate 
deleterious effects upon the human system. 

The external application of opium, especially to an 
abraded surface, may prove highly dangerous, and even 
fatal, especially in the case of infants. Christison relates an 
instance where a laudanum poultice, applied over the abdo- 
men of an infant to relieve pain, produced fatal narcotism 
in some hours ; and where, at the autopsy, a strong odor of 
opium was exhaled from the body, showing how completely 
the poison had been absorbed. 



334 TOXICOLOGY. 

Post-mortem appearances. — These are neither certain nor 
characteristic. There is usually some fullness of the vessels 
of the brain ; occasionally, extravasation of serum into the 
ventricles; very rarely of blood. Sometimes there is con- 
gestion of the lungs and other vascular organs. The blood 
is apt to be fluid. The stomach and bowels may be per- 
fectly natural in appearance. The odor of opium may be 
observed in opening the body. It is hence impossible to 
diagnosticate a case of opium-poisoning from the post- 
mortem appearances exclusively. 

Treatment. — Remove the poison from the stomach as 
speedily as possible, by the stomach-pump, or by a prompt 
emetic, as sulphate of zinc, or mustard water. The next indi- 
cation is to overcome the increasing lethargy, by rousing 
the patient, dashing cold water over the face and chest, and 
making him walk about between two attendants. He should 
swallow some strong coffee. Atropia should now be care- 
fully administered hypodermically, every half hour, watch- 
ing its effects upon the pupils. Electro-magnetism should 
be employed, if the other remedies fail. 

As regards the antagoiiism of morphia and atropia, our 
own experiments confirm those of Dr. John Harley, on the 
lower animals (dogs and cats), viz., that in these animals 
there is no real antagonism between these drugs. In the 
human subject, however, we think the accumulated testi- 
mony of physicians as regards their mutual antidotal 
operation cannot be disregarded ; our own experience in 
their employment also confirms this opinion {vid. ante, 

p. 185). 

Morphia. — When pure, morphia is in the form of color- 
less rhombic crystals, very bitter to the taste, very slightly 
soluble in water, soluble in alcohol, especially when hot, 
almost insoluble in chloroform and pure ether, very soluble 



POISONING BY MORPHIA. 335 

in acetic ether. It is slightly alkaline, forming salts with 
acids. Its solutions, in common with the other alkaloids, 
are precipitated by tannic acid. Its salts are soluble in 
water and diluted alcohol, but insoluble in chloroform, 
ether, amy lie alcohol and pure acetic ether. 

The symptoms produced by morphia resemble those of 
opium, except that they ordinarily manifest themselves 
rather earlier, and possibly tend to produce convulsions 
rather more frequently than opium. Occasionally, these 
convulsions were of a tetanic character, suggesting the 
presence of strychnia. 

Fatal dose. — One grain has, on several occasions, occa- 
sioned death. We have known a case where three-quarters 
of a grain administered hypodermically proved fatal to a 
gentleman within twenty-four hours. On the other hand 
(as in the case of opium), enormous doses have been swal- 
lowed with impunity. Dr. Norris reports a case {Am. Jour. 
Med. Sei , 1862, p. 395), where a druggist took, with 
suicidal intent, seventy-five grains of sulphate of morphia. 
No marked symptoms appeared for an hour and a half. He 
then became unconscious, but under active treatment, 
including extract of belladonna, he entirely recovered on 
the second day after the occurrence. 

The external application of morphia to an abraded sur- 
face has been attended with fatal effects. 

There are no characteristic post-mortem lesions produced 
by morphia. The general appearances are similar to those 
caused by opium. 

Chemical analysis. — There is no chemical test for opium, 
as such ; it is identified by its sensible properties, and by its 
physiological action on animals. The only mode of identi- 
fying it chemically is by detecting the presence of its mor- 
phia and meconic acid. 



336 TOXICOLOGY. 

Detection of morphia. — (i) In the solid state. — Strong nitric 
acid dissolves it with effervescence, evolving red fumes, and 
gives an orange-red solution, slowly fading to yellow. 
Nitric acid also produces a deep-red color with btaicia, which, 
on the addition of protochloride.of tin, changes to a bright 
purple; whereas no change is produced in the case of mor- 
phia. (2) Strong sulphuric acid dissolves it without change 
of color; if now a crystal of bichromate of potassium be 
added, it acquires a. green color. (3) Neutral perchloride 
or persulphate of iron imparts a deep blue color to it, 
changing to green if added in excess. For this experiment 
no free acid must be present. (4) Iodic acid added to a 
fragment of morphia, along with freshly-made starch, pro- 
duces the characteristic blue color from the liberated 
iodine. 

2. /// the liquid state. — (i) Nitric acid, in excess, gives 
an orange-red color, which becomes light yellow on boiling. 
(2) Neutral perchloride or persulphate of iron acts as on 
solid morphia. (3) Iodic acid in bisulphide of carbon added 
to a solution of morphia causes a precipitate of a pink or 
red color, consisting of iodine dissolved in the bisulphide. 
(Taylor), (4) Snlpho-inolybdic acid, made by dissolving five 
or six grains of molybdate of sodium or ammonium in two 
drachms of strong sulphuric acid. A drop of this reagent 
in contact with a fragment of morphia dissolves it, producing 
a beautiful violet color, changing soon to green and ulti- 
mately to a sapphire-blue. (5) If morphine be mixed with 
a little cane-sugar, and treated with concentrated sulphuric 
acid, a wine-red color is produced. (Weppen). 

The other tests mentioned in the books, such as ter- 
chloride of gold, iodine in iodide of potassium, bromine in 
hydrobromic acid, etc., are of less importance 

Meconic Acid. — As this acid is peculiar to opium, its de- 



OPIUM TOXICOLOGICAL EXAMINATION. 337 

tection affordg positive proof of the presence of that sub- 
stance. In its pure state, it occurs in the form of colorless 
crystals, tolerably soluble in water, more so in alcohol. 

Tests. — (i) Perchloride or persulphate of iron imparts to 
either the solid or liquid form a blood-red color, which is 
not removed by a solution of corrosive sublimate. The 
only fallacy likely to occur in a medico-legal case is from 
the presence of some sulpho-cyanide in the material examined, 
as the saliva, which yields a similar color with the iron salt; 
but the red color in the latter case is instantly discharged 
by corrosive sublimate. 

Strong acetic acid, or its salts, likewise give a red color 
with the ferric salts ; and this color, moreover, is not re- 
moved by corrosive sublimate. But if the acetate be pre- 
viously boiled with dilute sulphuric acid, it gives no color 
with the iron salt. (2) Acetate of lead yields a yellowish- 
white precipitate of meconate of lead. (3) Chloride of 
barium yields a white crystalline deposit of a peculiar form. 
(4) Nitrate of silver gives a yellowish-white precipitate, 
which becomes red on adding a persalt of iron. 

Toxicological examination. — Sometimes on opening the 
stomach the strong odor of opium is readily detected, and 
also in the matters vom ited. The discovery of this poison in 
the stomach is often unsuccessful,owing, probably, to its de- 
composition, and absorption in the body. This is especially 
true in the case of infants, in whom a very few drops suffice 
to destroy life. The highest authorities unite in declaring 
that the analyst will fail to discover this poison in the 
stomach after death, in the majority of the cases. It is 
much more likely to be found in the vomit. 

The stomach should be cut up in small fragments, adding 
water with a little alcohol, and acidulating with pure acetic 
acid, and the whole exposed to a gentle heat, for about one 



338 TOXICOLOGY. 

hour. After cooling, it should be strained through muslin, 
and the solid residue washed with strong alcohol and 
pressed, and the washings added to the first liquid. The 
liquid should then be evaporated over a water-bath to a 
small volume, and when cooled filtered through paper. To 
the clear filtrate, acetate of lead is to be added in excess, to 
precipitate the meconate of lead. The morphia remains in 
the solution as an acetate. These are to be separated from 
one another by filtration, and the solid matter washed with 
water. 

{a) The solid portion (meconate of lead) is to be diffused 
through water, and treated with sulphuretted hydrogen gas, 
which precipitates the black sulphide of lead, and leaves 
the filtrated meconic acid in solution; this latter is concen- 
trated by a gentle heat. A trial test on a small portion of 
this liquid, by the iron-salt, may be made; if a deep red 
color is imparted, meconic acid may be suspected ; to the 
remaincier of the liquid, the other tests may now be applied. 
If present in sufficient quantity, meconic acid will crystal- 
lize out, on evaporation of the liquid. If the quantity, how- 
ever, be minute, the liquid should be carefully concentrated 
to a small volume, and the characteristic tests employed. 

{p) The liquid portion, containing the morphia in the 
form of acetate, together with the excess of lead acetate, is 
to be treated with sulphuretted hydrogen in order to 
remove the lead ; then filtered, and the filtrate concentrated 
by gentle heat to dryness. The residue is then treated with 
a few drops of warm distilled water, and a portion of it ex- 
amined for morphia by the nitric acid and iodic acid tests. 
The remaining liquid should then be made alkaline by pure 
potassium carbonate (diluting, if necessary, with water) ; it 
is next to be shaken up with an excess of absolute ether, 
which will take up the impurities, leaving the morphia 



OPIUM DETECTION IN THE TISSUES AND BLOOD. 339 

unaffected. The ethereal solution Is removed by means of 
a pipette, and reserved for future examination. The re- 
maining alkaline solution is now to be thoroughly shaken with 
two or three times its volume of, either a mixture of two 
parts of absolute ether and one of alcohol, or of two or 
three volumes of hot amylic alcohol, or of a similar bulk of 
acetic ether. By either of these processes, the morphia is 
taken up by the solvent, which floats upon the top of the 
mixture, and which may be removed by a pipette and 
allowed to evaporate spontaneously on watch glasses. 
Ordinarily, the morphia thus recovered is amorphous, and 
may require resolution in hot alcohol, and to be crystallized 
therefrom by evaporation. 

In cases of poisoning by morphia alone (or one of its 
salts) the above process may be employed, omitting the 
acetate of lead, inasmuch as no meconic acid is present. 

Detection in the tissues and blood. — There is generally a 
failure to detect this poison in the organs and tissues, or in 
the blood. Yet, on the other hand, cases are reported where 
it has been discovered in the body several months after 
death. We can account for this discrepancy only on the 
supposition either that opium (morphia) undergoes some 
decomposition in the living organism, which interferes with 
its detection by chemical analysis, or else that life has been 
prolonged sufficiently long to allow of its diffusion through- 
out the body so thoroughly, as to render it impossible to 
detect it in any one particular organ ; this would be 
especially the case if the dose had been comparatively 
small, as where an infant had died from a few drops of 
laudanum. There is some doubt about the detection of 
these principles in the iirine, inasmuch as the results 
alleged to have been produced by certain reagents, and sup- 
posed to indicate the presence of morphia, or meconic acid, 



310 TOXICOLOGY. 

have since been proved to be due to substances existing 
normally in the urine. 

The toxicologist should be cautioned against a too hasty 
conclusion as to the presence of opium, or its alkaloid, in a 
medico-legal case, based upon the color alone. Orfila tells 
us (Toxicol. ^W, p. 232) that Mm. Ruspini and Cogrossi found 
that a decoction of a calf's intestines, although no morphia 
was present, acted upon iodic acid and starch like that alka- 
loid. In another case, morphia was pronounced to be 
present in the urine, by reason of the action of the extract 
of this secretion on iodic acid ; the effect was found to be 
really due to uric acid and urate of ammonia. 

Inasmuch as the symptoms of opium-poisoning strongly 
resemble those of apoplexy, it could readily happen that a 
case of the latter disease, attended with suspicious sur- 
roundings, might be mistaken for the former, and the con- 
tents of the stomach might even probably reveal a red 
color, when treated with nitric acid. But, if no morphia 
(nor meconic acid) was actually separated, we think the 
examiner would not be authorized to pronounce upon the 
presence of this poison simply from the one single reaction 
above mentioned. Prof Taylor cites an instructive illus- 
tration of this hasty conclusion, in which a certain distin- 
guished (?) chemist made oath of the discovery of *' distinct 
traces of morphia " in the stomach ; whereas, in reality, no 
morphia had been taken at all (as was proved by an analysis 
of the medicine taken by the deceased) ; but the death was 
due entirely to natural causes. 



POISONING BY ALCOHOL SYMPTOMS. 341 

SECTION II, 
POISONING BY ALCOHOL. 

ACUTE ALCOHOLISM. — SYMPTOMS. — POST-MORTEM LESIONS. — CHEM- 
ICAL ANALYSIS. — DETECTION IN THE TISSUES. 

The poisonous effects of Alcohol are of a twofold char- 
acter — acute and chronic. The former are witnessed in 
those cases where a large quantity of spirits is taken at a 
single draught, as in a silly bravado, or for a wager, and 
also accidentally by young children. The latter are illus- 
trated in the common dram drinkers, and by a train of 
symptoms with which we are, unfortunately, but too familiar. 
The former only will be discussed here. 

Symptoms of acute poiso7ting. — These come on usually in 
a few minutes after the ingestion of the poison, if the amount 
is large. They are, first, giddiness, confusion of ideas, un- 
steadiness of gait, incoherent talking, followed by stupor 
and coma. The features have a vacant, ghastly expression, 
or they may be suffused and bloated ; the lips are livid ; the 
pupils usually dilated and fixed ; the conjunctivae are red; 
an alcoholic exhalation from the breath is perceived; con- 
vulsive movements of the limbs ; respiration, at first sterto- 
rous, becomes more and more difficult ; a bloody froth may 
appear on the lips; involuntary evacuations occur, and death 
may ensue in half an hour, or even earlier, after the fatal 
drink (Tardieu). In other instances, the person may appa- 
rently recover from the first effects, and then suddenly be- 
come insensible, and die in convulsions. If free vomiting 
occurs, followed by a prolonged sleep, recovery is apt to 
take place. The sensibility of the pupil to light may also 
be regarded as a favorable symptom. 

The rapidity with which the symptoms show themselves 
will depend upon the previous habit of the individual, and 



342 TOXICOLOGY. 

the strength and quantity of the spirit taken. The very 
large quantities seem to destroy hfe by shock. 

Acute alcoholism may be mistaken for opium-poisoning 
and concussion of the brain. Usually, the odor of the 
breath is sufficient to reveal the case; also, the dilated 
pupil; but this condition of the eye is not invariably present. 
In concussion, there are often marks of injury in the head; 
the face is pale and cold ; there is also an absence of the 
alcoholic odor. 

Post-mortem appearances. — There is generally a remark- 
able absence of putrefaction in the body. The stomach 
exhibits marks of intense congestion, in the deep-red color 
of its lining membrane, either diffused or in patches. More 
or less congestion of the brain and its membranes, with 
serous effusion under the arachnoid, and in the ventricles. 
Sometimes, there is a true apoplectic extravasation of felood. 
The lungs are almost invariably congested. Usually, a 
strong alcoholic odor is perceived from the different tissues 
of the body; but the organs for which the poisonous fluid 
displays the greatest affinity are the brain and liver. 

Alcohol is very rapidly absorbed into, and eliminated from 
the system ; so that, if the person has survived several 
hours, all traces of it may have been removed from the 
body. 

Treatment. — Immediate evacuation by means of the 
stomach pump, or by an active emetic ; affusion of cold 
water over the head ; a free supply of fresh air ; if there be 
asphyxia galvanism may be tried, also ammonia and the 
liberal use of coffee as a drink. 

Chemical analysis. — If the case has not been too pro- 
tracted, the alcohol may be recovered from the stomach and 
its contents by distillation in a capacious retort, on a water- 
bath, with a good condensing apparatus. If the materials 



ALCOHOL DETECTION IN THE TISSUES. 343 

are acid, they should first be neutrahzed by carbonate of 
potassium or sodium. The distillate should be mixed with 
chloride of calcium, and re-distilled. The second distillate 
is to be shaken with an excess of carbonate of potassium 
(which absorbs the water) and set aside. The stratum of 
alcohol which rises to the top may then be separated by 
means of a pipette, and submitted to the following tests : 
(i) Its taste is hot and pungent; its odor is characteristic. 
It burns with a pale blue flame, leaving no carbonaceous 
residue, but yielding carbonic acid and water ; if burnt 
under the mouth of a test-tube moistened with lime or lead 
water, the carbonic acid will produce a white film upon the 
sides of the tube. (3) It dissolves camphor. (4) On adding 
a solution of bichromate of potassium and sulphuric acid, 
the peculiar odor of aldehyde is developed, along with the 
green color of chrome oxide. In performing this latter test, 
Prof Taylor recommicnds conducting the vapor from the 
retort in which the distillation is going on into a glass tube 
containing a few fibres of asbestos moistened with a mix- 
ture of a strong solution of the bichromate and sulphuric 
acid, when the merest trace of alcohol vapor will be 
sufficient to impart the green coloration. 

Both etJier and pyroxylic spirit (wood spirit) will produce 
this last effect, and likewise yield most of the results of 
alcohol. Ether may be distinguished by its odor^ and by 
the yellow color of its flame ; also by its smoky deposit on 
porcelain. Pyroxylic spirit may be recognized by its 
peculiar odor, and by its smoky flame on burning. 

In the tissues. — The proof of the absorption of alcohol is 
afforded in its detection in the blood, urine, and different 
tissues of the body. If there is a failure to discover it in 
the stomach, it should be looked for in the brain and liver. 
Buchheim has devised an exceedingly delicate process for 
detecting it in small quantities in the blood and tissues, 



344 TOXICOLOGY. 

based upon the conversion of the vapor of alcohol into 
aldehyde and acetic acid when passed over platinum-black. 
As much as possible of the material, neutralized first by 
carbonate of potassium, should be distilled from a capacious 
retort, on a water-bath. The neck of the retort should be 
slightly inclined, and be wide enough to hold a platinum 
tray about two inches long and half an inch wide, containing 
the platinum-black. Hanging over each end of the tray is 
placed a slip of moistened litmus paper, and touching the 
platinum-black. The tray is now pushed toward the body 
of the retort. As soon as there is any escape of alcoholic 
vapor by the distillation, it will be manifested by the red- 
dening of the litmus paper at the farthest end of the tray, in 
consequence of the production of acetic acid, while the 
paper nearest the body of the retort will remain blue. If 
no reddening of the paper occurs, no alcohol can be present ; 
if the reddening rapidly occurs, the tray should be removed, 
and the vapor should be condensed in the usual way. 

As both ether and wood spirit produce a similar effect on 
platinum-black, this process offers no advantage over the 
chromic process above described, except when putrefaction 
has taken place, in which case the sulphuretted hydrogen 
evolved might reduce the chromic acid, but it would not 
affect the platinum-black (Taylor On Poisons, p. 643). But 
we may remark it is hardly supposable that the analyst 
would undertake to separate alcohol from 2i putrefied body . 

A new test for alcohol is given by Lieben (Phar. Jour. 
1869). A few grains of iodine and a few drops of solution 
of caustic soda are introduced into a test-tube, along with 
the suspected fluid. It is then heated without boiling, when 
iodoform is precipitated. It is stated that one part of 
alcohol in two thousand of the mixture can thus be de- 
tected ; also, that it may thus be discovered in the urine 
after drinking, by first distilling it. 



POISONING BY ETHER. 345 



CHAPTER XXVI. 

(2) ANESTHETICS. 

This subdivision of Cei'ebral Neurotics comprises those 
substances that display their power chiefly by producing 
insensibihty to pain, and unconsciousness. The Anaesthetics 
here noticed are Ether and Chloroform. Under this head 
also it will be convenient to speak of Chloral Hydrate, 
although its action differs somewhat from that of the 
others. 

SECTION I. 

POISONING BY ETHER, CHLOROFORM, AND CHLORAL 
HYDRATE. 

Ether. — Generally known as Sulphuric ether, because pro- 
cured by the distillation of alcohol and sulphuric acid. It is 
a limpid, colorless liquid, of a peculiar odor, and hot, pungent 
taste; highly volatile and inflammable; sp. gr. 0.735 ; boils 
at 95° F.; burns with a bright yellow flame, depositing 
carbon on a cold porcelain surface. Sparingly soluble in 
water ; very soluble in alcohol. 

Symptoms. — In large doses, it produces much the same 
effects as alcohol. There is, usually, a short period of 
delirious excitement, followed by coma and other symptoms 
of narcotism, similar to those caused by alcohol. 

Post-mortem appearances. — On account of its less solu- 
bility in water, ether is a more powerful local irritant than 
alcohol. The mucous lining of the stomach and duodenum 
of a dog poisoned with ether were found to be violently 
inflamed ; the lungs deeply congested, and the heart full of 
black blood (Orfila, Toxicol., II, p. 531). 
16 



346 TOXICOLOGY. 

The inhalation of ether, as is well known, produces rapid 
anaesthesia, on account of its prompt and speedy action on 
the brain. Its immediate effect, when inhaled, is the pro- 
duction of a transient excitement ; this is soon followed, if 
the dose be sufficient, by stupor and insensibility. This 
last condition may be prolonged for a considerable time by 
continuing the inhalation. Occasionally, the excitement is 
of a violent character, along with a stubborn resistance to 
the anaesthetic influence; and again, there maybe nausea 
and vomiting. These exceptional symptoms must be 
ascribed to the constitutional peculiarities of the patients. 

Although, in a few instances, the inhalation of ether has 
been attended with fatal consequences, we are of the opinion 
that it is a much safer anaesthetic than chloroform. 

Chemical analysis. — Ether is recognized by its odor and 
taste, by its mode of combustion and volatility, and by its 
action on sulphuric acid and bichromate of potassium — the 
same as in the case of alcohol. 

From organic mixtures, as, e. g., the contents of the 
stomach, it is to be separated by the same process as that 
described for alcohol (vid. p. 343). 

Chloroform. — A colorless, limpid liquid, very volatile, 
giving off a dense vapor ; sp. gr. 1.497; boiling point, 142° F. 
It has an agreeable characteristic odor, and a smart, pungent 
taste. It is nearly Insoluble in water, in which it sinks in 
globules. It is not inflammable, like ether and alcohol. It 
is a powerful solvent of many organic substances, the alka- 
loids among others. At a red heat. Its vapor is decomposed 
into chlorine and hydrochloric acid. 

Sympto7ns. — A large dose produces local irritation to the 
stomach, with, at first, a general stimulation of the whole 
system, soon followed by decided narcotism, as shown by 



POISONING BY CHLOROFORM. 347 

insensibility, stupor, convulsions, dilated pupils, flushed face, 
full and oppressed pulse, and frothing at the mouth. Cases 
are reported where the pupils were contracted. 

Dr. Taylor reports a case where a boy, aged four years, 
died in about three hours, after swallowing one drachm of 
chloroform. It has often caused death in quantities of half 
an ounce and upward. 

When taken by inhalation^ its impression is more speedy 
than that by ether. There is, moreover, an absence of the 
previous excitement attendant on the latter, the patient 
almost immediately passing into insensibility. It appears 
to act as a depressant from the first, and if not properly 
diluted with atmospheric air, it may rapidly produce death. 
In one case, the fatal result took place in one minute after 
breathing only thirty drops in the state of vapor ; and, in 
another instance, only fifteen drops proved fatal in a very 
short time. It is, undoubtedly, a far more dangerous anaes- 
thetic agent than ether, and instances of its fatal effects are 
being constantly reported in the medical journals. The 
immediate cause of death from chloroform vapor appears to 
be, in the majority of cases, syncope, or the cessation of the 
heart's action ; in others, asphyxia. 

Post-mortem appearances. — In death from liquid chloroform, 
the characteristic odor may usually be recognized, together 
with slow putrefaction of the body, and persistent rigor 
mortis. There is also much irritation of the stomach, some- 
times accompanied with softening, and in one case with 
ulceration. 

In death from inhalation, there is very often no lesion 
discoverable. At times, there will be found considerable 
congestion of the lungs and bronchial tubes, and likewise 
of the vessels of the brain, together with a dark and fluid 
condition of the blood. 



348 TOXICOLOGY. 

Treatment. — In poisoning by liquid chloroform, the 
stomach should be immediately evacuated by the stomach- 
pump, or by a prompt emetic, and stimulants afterward 
administered. If inhalation has caused the danger, the 
chloroform should be immediately withdrawn, and fresh air 
freely admitted ; cold affusion should be applied to the face 
and chest ; the tongue should at once be drawn out of the 
mouth, to facilitate respiration ; artificial respiration, and the 
direct galvanic current should also be practiced. 

Chemical analysis. — The odor will usually be present in 
organic mixtures, such as the contents of the stomach. 
These should be distilled on a water-bath, and the distillate 
re-distilled along with chloride of calcium, and the product 
subjected to the proper tests, as odor, taste, solubility, etc. 

Toxicological examination. — The contents of the stomach, 
or the organs properly divided along with distilled water, 
should be put into a large flask, the neck of which is fitted 
with a cork perforated to contain a hard glass tube, bent at 
right angles, and from twelve to fifteen inches long. The 
flask is gradually heated on a water-bath, and at the same 
time the middle of the horizontal tube is heated red-hot by 
a Bunsen flame. At a red heat, chloroform is decomposed 
into chlorine and hydrochloric acid. A slip of moistened 
litmus paper placed at the mouth of the tube is first red- 
dened, and then bleached ; starch paper wetted with iodide 
of potassium is rendered blue; and if the end of the tube be 
made to dip into a solution of nitrate of silver, the white 
chloride of silver will be precipitated. The absence of any 
free hydrochloric acid in the original material should be 
first insured, by the addition of carbonate of sodium. 

It is important to remember that if hydrate of chloral had 
been taken by the patient just previous to death, and the 
alkali be added to the mixture for examination, the chloral 



POISONING BY HYDRATE OF CHLORAL. 349 

would be decomposed into chloroform, and produce all the 
above reactions. 

There are certain important medico-legal questions con- 
nected with the administration of chloroform as an anaes- 
thetic, with which the legal physician should be familiar, 
such as whether persons asleep may be chloroformed with- 
out their being awakened, and thus robbed or otherwise 
maltreated. It has been ascertained by direct experiment 
that this effect can be produced if the sleep is profound, but 
not if it is slight or partial. 

Hydrate of chloral. — A solid, crystalline body, result- 
ing from the action of chlojine on alcohol. It has a peculiar, 
disagreeable, pungent taste and smell ; is tolerably soluble 
in water ; not inflammable. Potassa added to its boiling 
aqueous solution instantly converts it into chloroform and 
formic acid. It decomposes a salt of copper, like grape 
sugar. 

Symptoms. — Chloral has been introduced into medical 
practice within comparatively few years, as a hypnotic. Its 
indiscriminate use has led to many fatal results. Care 
should always be exercised not to repeat the dose too fre- 
quently, as there appears to be a tendency to accumulation, 
and a sudden and dangerous action of the drug. In 
moderate doses, it acts on the brain as a hypnotic ; in large 
doses, it produces a powerful depressant action on the gan- 
glia at the base of the brain, and the spinal cord, causing 
feeble action of the heart and lungs. 

A full dose usually occasions deep sleep, followed, if the 
quantity be very large, by fatal coma. The pulse is usually 
very slow and feeble ; the face pale ; respiration slow, the 
heart being ultimately arrested in diastole. 

Much discrepancy of opinion exists as regards the fatal 



350 TOXICOLOGY. 

dose of chloral hydrate. Numerous instances are reported 
where ordinary doses of thirty grains have occasioned 
alarming, and even fatal effects ; while, on the other hand, 
enormous quantities — over an ounce — have been swallowed 
with comparative impunity. As a rule, thirty grains may 
be considered as a safe maximum dose, and not to be 
repeated oftener than every six or eight hours. 

The opinion of Liebreich, of Berhn, is that chloral, while 
circulating in the blood, undergoes decomposition into 
chloroform and formic acid, through the agency of the 
alkalies of the blood. 

Chemical analysis. — The principle involved is the conver- 
sion of the chloral into chloroform, through the agency of 
an alkali, as explained above. The solid matters, properly 
divided, should be diluted with distilled water and rendered 
alkaline by caustic potassa, and heated in a flask, and the 
experiment conducted after the manner described under the 
head of Chloroform. 



POISONING BY NUX VOMICA. 351 



CHAPTER XXVII. 

ORDER II.— SPINAL NEUROTICS OR TETANICS.— POISONING 
BY NUX VOMICA.— STRYCHNIA. 

POISONOUS DOSE OF NUX VOMICA. — EFFECTS OF STRYCHNIA. — FATAL 
DOSE. — TREATMENT. — POST-MORTEM LESIONS. — DIAGNOSIS. — 
CHEMICAL ANALYSIS. — INTERFERENCES. — PHYSIOLOGICAL TEST. — 
TOXICOLOGICAL EXAMINATION. 

Nux Vomica is by far the most important poison included 
under this order of Neurotics. It is the seeds of the Strych- 
nos nux vomica^ a tree growing in India. Several seeds are 
enclosed in a yellow fruit. These seeds are circular disks, 
an inch or less in diameter, concavo-convex, of a light 
brown color, covered over with short, whitish, silky hairs, 
extremely tough and difficult to pulverize ; excessively 
bitter to the taste. They contain two powerfully poisonous 
alkaloids — strychnia and brucia, in combination with strych- 
nic or igasitric acid. The amount of contained strych- 
nia is estimated at one-half to one per cent, of the seed. 

The smallest fatal dose of nux vomica is thirty grains 
•(about the weight of one seed), and three grains of the alco- 
holic extract. The symptoms, treatment, etc., are precisely 
similar to those described under the head of Strychnia. 

Strychnia. — Exists in several species of Strychios besides 
the S. nux vomica ; it is the poisonous principle of the 
6". Ignatia, or St. Ignatius bean ; it is also found in False 
Augustura bark. 

Strychnia is a very frequent cause of poisoning, whether 
accidental, homicidal, or suicidal. The celebrated Palmer 



352 TOXICOLOGY. 

case, which occurred in England, in 1856, brought it prom- 
inently before toxicologists. 

Symptoms. — These vary somewhat in the time of their 
appearances, according to the form of their administration. 
The first effect is a feehng of restlessness and general un- 
easiness, with a sense of impending suffocation, and want of 
air. Very soon, twitching of the muscles and jerking of the 
hmbs and head come on. These are followed suddenly by 
a violent tetanic convulsion, which pervades the whole 
body; the legs are stretched out stiffly, and widely sepa- 
rated ; the feet arched, and usually turned in ; the arms are 
flexed, and tightly drawn across the chest; the head is bent 
back rigidly, and the whole body flexed backwards so as to 
rest upon the head and heels (opisthotonos^. As the muscles 
of the chest and abdomen are spasmodically contracted, the 
respiratory movements become arrested ; the face is livid 
and congested, especially around the lips ; the eyes promi- 
nent and staring ; pupils widely dilated ; the muscles about 
the mouth contracted so as to produce the expression de- 
nominated risiis sardonicus ; the pulse is very rapid and 
feeble. Sometim.es, there is foaming at the mouth, and the 
froth may even be tinged with blood. The intellect remains 
perfectly clear, while the patient is experiencing the most 
intense suffering, gasping for breath, and seeking in vain for 
relief in asking to be turned over, or moved, or held. The 
jaws are not always fixed during a paroxysm ; the patient 
may hence be able to speak ; and as there is often great 
thirst, he may ask for water, but the effort to swallow is apt 
to intensify the spasm, as in hydrophobia, and cause him to 
bite upon the vessel. 

The paroxysm may last from half a minute to several 
minutes, when a complete relaxation occurs ; the patient 
now feels exhausted, and is bathed in perspiration ; the 



POISONING BY STRYCHNIA. 353 

pupils may now become contracted. In a short time — var>'- 
ing from a few minutes to half an hour — the fit returns. It is 
usually preceded by an apprehension of the impending 
danger, the special senses being exceedingly acute. The 
spasm may be brought on by the slightest cause, as the 
opening of a door, a sudden noise, a current of air, or an 
attempt to move. In some instances, the violence of the 
spasm is so great as to jerk the patient out of bed. Should 
the case prove fatal, the paroxysms increase in frequency 
and violence, until at last death ensues, either from asphyxia, 
the patient dying in a paroxysm, or from pure exhaustion, 
during an interval. 

Although the intelligence , continues unimpaired during 
the progress of the disease, it may happen that it becomes 
clouded just before the fatal termination, in consequence of 
the asphyxia causing a deficiency of aeration of the blood, 
and the consequent accumulation of carbonic acid. As a 
rule, when the paroxysms are once established, they progress 
either to a fatal termination, or toward a cure, within two 
hours of the seizure, though there may be some exceptions 
to this rule. 

The time of the first manifestation of the symptoms varies 
from a few minutes, to some hours; the average is fifteen 
minutes, to half an hour. Dr. G. H. Barker reports {Am. 
four. Med. Sci., October, 1864) the case of a young, healthy 
woman, who took six grains of strychnia, in whom violent 
symptomis were manifested. in thj^ee minutes, and death took 
place, in a convulsion, in half an hour. In Dr. Warner's 
case, who took, it is supposed, less than half a grain, the 
symptoms appeared in five minutes, and death occurred in 
about eighteen minutes. In a case mentioned in the Ann. 
d' Hygiene, 1861, I, p. 133, convulsions came on in five 
minutes. On the other hand, this interval may be pro- 
16* 



354 TOXICOLOGY. 

tracted for several hours. Dr. Anderson reports {Am. Jour. 
Med. vSa., April, 1848) the case of a gentleman who took, 
by mistake, three and a half grains of strychnia, and expe- 
rienced no particular symptoms for two hours and a Jialf^ 
when he suddenly fell backward; but, on being raised, he 
was able to walk home, and finally recovered. Undoubtedly, 
the form in which the poison is administered has much to 
do with the rapid development of the symptoms. This is 
shown in a case cited by Dr. Taylor (Priii. and Prac. of Med. 
Jnrisp., 1873, p. 405), of a boy aged twelve years, who swal- 
lowed a pill containing three grains of strychnia, in whom 
no symptoms were manifested for three hours ; they then set 
in with their usual violence, and death took place in ten 
minutes. This pill had been prepared with mucilage eight 
months before, and was consequently hard and difficult to 
dissolve. In the Palmer case. Cook took two pills con- 
taining strychnia. No symptoms were observed for an 
hour and a quarter, after which death occurred in twenty 
minutes. 

It must, however, be admitted that there are cases where 
the unusual delay cannot be thus accounted for, but where 
it must be referred to some individual peculiarity of the 
patient. Dr. Wormley {Micro. Chem. of Poiso?is, p. 40) men- 
tions a case where the remarkable postponement of the 
symptoms for twelve hours appeared to be owing to the 
effects of a large dose of opium that had been taken simul- 
taneously. Three grains of strychnia, a drachm of opium, 
and an indefinite quantity of quinine were taken at the 
same time [vid. ante., p. 184). Other equally remarkable 
instances might be adduced, showing the same apparent 
antagonism between strychnia and opium. Nevertheless, in 
some experiments of the author, made on animals with 
strychnia and morphia combined, the latter poison, so far 



POISONING BY STRYCHNIA FATAL PERIOD. 355 

from antagonizing the former, appeared rather to intensify 
it {vid. ante., p. 185). 

The subcutaneous injection of strychnia, as also its ex- 
ternal application to a healthy mucous surface, produces a 
still more speedy manifestation of its peculiar symptoms. 
Some clinical experiments of Dr. Chisholm, of Baltimore, 
made on amaurotic patients, would seem to show that the 
human system acquires a tolerance of strychnia {Am. Jour, 
Med. Sci., April, 1872). 

Fatal dose. — There is great difference as to the suscepti- 
bility to the action of strychnia.- The average medicinal 
dose is about the one-sixteenth of a grain, though it is cus- 
tomary to commence with a smaller quantity. The above 
dose has proved fatal to a child between two and three years 
old. Dr. G. B. Wood mentions the case of a lady who 
wast hrown into alarming spasms by one-twelfth of a grain 
(Therap. I, p. 834). The author has seen the case of a 
gentleman who had decided spasms after taking about 
one-twentieth of a grain. 

The smallest fatal dose for an adult recorded is half a 
grain, which proved fatal to Dr. Warner. Dr. Ogston reports 
a case where three-quarters of a grain destroyed a man in 
three-quarters of an hour. A fatal dose for an adult may 
be stated to be half a grain^ to one grain. 

On the other hand, numerous instances are recorded of 
recoveries after enormous doses of this poison — ten, twelve, 
and ^v^n forty grains. In all these cases early vomiting 
was produced, which, doubtless, removed the strychnia 
before it was absorbed to a fatal extent. Besides, it is quite 
possible that the poison was not of full strength. 

Fatal period. — This, like the fatal dose, is liable to con- 
siderable variation. Dr. Warner's case terminated fatally in 
eighteen minutes. Dr. Taylor mentions two cases in which 



356 TOXICOLOGY. 

death occurred in ten and fifteen minutes respectively ; in 
another case, in five minutes ; in two others, in thirty 
minutes each. 

On the other hand, hfe has been prolonged, even after 
large doses, for several hours. In Cook's, case, death 
occurred in an hour and a quarter after swallowing the pill. 
In the case of a woman examined by the author, death did 
not occur for six hours after swallowing about six grains of 
strychnia {Am. Jour. Med. Sci., Oct., i86i,p. 409). Sir R. 
Christison reports a case in which a man died in fifteen 
minutes after swallowing a dose of 7tux vomica. 

Treatment. — Prompt and free emesis is of the greatest 
importance. Copious draughts of warm mustard water, or 
a mixture of ipecac and sulphate of zinc should be given. 
The stomach pump may be used if the spasm of the jaws 
will permit. Chloroform, by inhalation, appears to have 
been attended with the happiest results. The patient should 
be constantly kept under its influence, carefully watching its 
effects. We would strongly advise its early administration. 
Bromide of potassium has also been given with the best 
results — sixty to eighty grains every hour, or half hour. 
Hydrate of chloral has also proved an efficient remedy in 
several cases, and nitrite of amyl has been recommended, 
from its known physiological effects. Atropia has also 
proved efficacious as an antidote in a case where chloroform 
failed, and where the paroxysms were very severe (Ed. 
J/^(/. /<?//!r., Sept., 1 873). 

As regards the remedial effects of tobacco^ tincture of iron, 
tincture of iodine and aconite, we deem them of no value. 
We have experimented with them all on dogs that were 
poisoned with strychnia, but in no case did any of them 
exhibit antidotal powers. 

Post-mortem appearances. — These are by no me^ns char- 



POISONING BY STRYCHNIA DIAGNOSIS. 357 

acteristlc, nor are they always similar. Probably, the lesions 
most commonly observed are congestion of the brain and 
membranes, and of the spinal cord, with engorgement of the 
lungs, and a dark and fluid condition, of the blood. The 
heart is sometimes contracted and empty, and at others full 
of blood. The rigor mortis is usually prolonged; in one 
case, we found it existing six weeks after death. There is 
also frequently noticed a livid appearance about the mouth 
and tongue, and also of the fingers and toes. It should be 
remembered that certain disorders of the brain and spinal 
cord, attended with tetanic convidsio)is, will leave precisely 
similar lesions to those just referred to as following death 
by strychnia. 

Diagnosis. — The importance of a clear diagnosis, in a 
medico-legal case of strychnia-poisoning, cannot be too 
strongly urged, inasmuch as there may be, in such a case, 
a complete absence of all chemical proof In the celebrated 
Palmer case, this question was most thoroughly sifted on 
both sides. Indeed, this very case affords an apt illustration 
of just the sort of difficulties that present themselves in 
forming a correct appreciation of the symptoms. In the 
Palmer case, the defence brought forward an immense array 
of diseases, which, as remarked by Tardieu, " have but a 
faint resemblance to, and often a complete diversity from, 
the characteristic phenomena of strychnia-poisoning." The 
only disease whose symptoms can possibly be confounded 
with those occasioned by strychnia, is tetanus^ in its varie- 
ties of idiopathic, traumatic and hysterical, and possibly 
some forms oi epilepsy. 

If the expert were obliged to decide solely from the con- 
vulsion — apart from its mode of invasion and seizure, its 
duration and termination, the condition of the intervals 
between the paroxysms, in fine, apart from the whole history 



358 TOXICOLOGY. 

of the attack — he might probably be unable to discriminate 
between a case of strychnia-poisoning and one of tetanus ; 
but where a careful examination of all these attending 
circumstances has been instituted, there can be no possible 
difficulty in reaching a satisfactory conclusion. The dis- 
tinctive characters are the following: (i) In traumatic 
tetanus, the history of the case, as being connected with 
some injury, such as a lacerated, contused, or punctured 
wound, involving tendons, nerves and fasciae, will always 
throw sufficient light on the case to admit of an easy diag- 
nosis, although it must not be forgotten that the most trifling 
injury, such as the insertion of a splinter of wood beneath 
the fascia, and which may have entirely escaped recollec- 
tion, may, after the lapse of several days, give rise to this 
frightful disorder ; and such a case might be mistaken for 
idiopathic tetanus. But as regards the latter form of the 
disorder, besides its extreme rarity in temperate climates, 
its mode of invasion (as likewise that of traumatic tetanus), 
the duration of the attack and the character of the symptoms, 
are entirely different from those of strychnia-poisoning. In 
the former there are always manifested certain prodromes, 
such as chills, faintness, insomnia, headache, vertigo, and 
painful tension about the diaphragm, which may last for 
several days. These, of course, are entirely wanting in 
poisoning by strychnia, and they never can be mistaken for 
the general uneasiness which precedes /<?rd?;2/^ (^/^ze; minutes 
the sudden outburst of convulsions, in the case of the poison. 
(2) The first symptoms in tetanus are a painful stiffness of 
the neck and jaws, with a difficulty of moving the head; 
after this, there is a gradual spreading of the rigidity over 
the muscles of the other parts of the body, usually the trunk 
first, then the limbs. In some instances the contractions 
reach their greatest intensity in the course of a few hours ; 



POISONING BY STRYCHNIA DIAGNOSIS. 359 

in others, several days may elapse. To contrast this with 
a case of strychnia-poisoning : in the latter, instead of the 
gradual invasion of the rigid spasms, commencing in the 
neck or jaws, there is a sudden tetanic seizure of all the 
muscles of the body simultaneously, producing the violent 
jerking of the body, and the arching of it backwards. Again, 
while the muscles of the neck and jaws are never the first 
to be affected by strychnia, but are often the last, the re- 
verse is the case in the disease — the trismus being the first 
indication of its approach. (3) A third distinction is founded 
on the progress of the two cases : whilst the violent par- 
oxysm produced by strychnia lasts only from half a minute 
to one or two minutes, and is succeeded by a complete re- 
laxation, in tetanus, on the contrary, the rigidity is generally 
permanent, or if there be any remissions, these never ex- 
hibit the character of the complete intermissions character- 
izing the action of strychnia. (4) The termination of the 
cases is widely different ; idiopathic tetanus never terminates 
fatally in two or three hours, but usually several days 
elapse; whilst in the case of the poison, death often occurs 
within half an hour, to two hours. Some cases of traumatic 
tetanus are reported, which proved fatal within twelve hours ; 
and one remarkable case, quoted by Watson (Lectures^ art. 
Teta7tus), of a negro who lacerated his thumb by the acci- 
dental fracture of a china dish ; he was seized with convul- 
sions almost instantly, and died with tetanic symptoms in a 
quarter of an hour. 

As regards the hysterical form of tetanus, although its 
very existence has been denied by some, especially in the 
male, it is admitted by numerous competent authorities ; 
and, inasmuch as among other forms it may assume that of 
tetanic spasms, and might occasion doubt, under peculiar 
circumstances, the examiner should ascertain the previous 



360 TOXICOLOGY. 

history of the case, which will serve to clear up the diag- 
nosis. 

In relation to epilepsy^ there ought to be no difficulty in 
the diagnosis ; the mode of seizure, the unconsciousness, 
and the peculiar clonic movements, are wholly different from 
the characteristic tetanic spasm of strychnia-poisoning. 
Again, the deep stupor which terminates an epileptic attack 
contrasts widely with the complete relaxation and perfect 
intelligence that follow the strychnia spasm. 

Chemical analysis. — Strychnia occurs in the form of a 
white powder, and also in crystals, usually prismatic. It is 
almost insoluble in water — one part in seven or eight thou- 
sand. Absolute alcohol dissolves one part in about two 
hundred; amylic alcohol, one in one hundred and twenty ; 
pure ether, one in about fourteen hundred ; commercial ether, 
one in about one thousand ; cJiloroform, one part in eight. 
It is insoluble in the fixed alkalies, and very sparingly so 
in ammonia. 

The salts of strychnia are very soluble in water and 
alcohol, but very slightly so in ether. 

The taste is intensely and permanently bitter. This is one 
of its characteristic qualities. In fact, it is the bitterest sub- 
stance known. As the result of numerous experiments, we 
have found distinct bitterness yielded by a solution of one 
grain of strychnia in several gallons of water. This bitter 
taste we regard as one of the strongest corroborative proofs 
of the presence of strychnia in a medico-legal case. Unless 
the ultimate extract obtained by the manipulation has a bitter 
taste, we need hardly expect to prove the presence of the 
poison by the usual chemical tests. But, of course, the mere 
presence of bitterness is not evidence of strychnia, since this 
quality pertains to numerous other substances, such as 
morphia, quinia, aloes, colocynth, quassia, picrotoxia, etc. 



POISONING BY STRYCHNIA THE COLOR TEST. 361 

The strong mineral acids produce no coloration with 
strychnia, provided the latter is pure ; if it contains brucia, 
it will impart a reddish color to nitric acid. Heated on 
porcelain, it melts slowly into a brown liquid, and is decom- 
posed, giving off dense white fumes, and leaving carbon. 
It may be sublimed by heat, depositing crystals of pennate 
forms on a cold glass surface (Guy). 

I. The Color test. — This is so named on account of the 
beautiful succession, or play of colors, that is developed by 
it. It consists in the application of a drop of pure sulphuric 
acid to a small fragment of strychnia, on a white porce- 
lain surface, or on a watch glass over white paper. If the 
strychnia be perfectly pure, it will dissolve in the acid with- 
out any coloration. If now a fragment of bichromate of 
potassium, binoxide of manganese, binoxide of lead,ferrocya- 
nide of potassium, or permanganate of potassium, be stirred 
in contact with the solution, by means of a pointed glass 
rod, this play of colors is instantly manifested. At first, it is 
of a rich, deep blue ; this soon passes into violet and purple, 
which, in its turn fades into a pink, and finally into a red. 

The relative duration of these shades of color depends 
on the quantity of strychnia operated on, and also on the 
relative amounts of acid and the other substance. Thus, if 
the amount of strychnia be extremely minute, the blue 
color may flash out but for a moment, leaving only the 
violet or purple, which quickly passes into the red. 

The principle involved in the color test is the action of 
nascent oxygen (developed by the sulphuric acid on the 
various oxidizing substances above named) on the strychnia. 
For the success of the experiment, it is immaterial which 
one of these oxidizing bodies is employed, providing it is 
pure. Different authorities evince a preference for one or 
another, according to their individual tastes. As a rule, the 



362 TOXICOLOGY. 

pure crystal of bichromate of potassium will yield satisfac- 
tory results. 

It is very important for the medico-legal student to have 
clear and definite ideas about this color test for strychnia. 
It is not the mere production of a blue color that is of 
diagnostic value, for this might result from the application 
of permanganate of potassium to various organic bodies in 
the absence of strychnia ; but it consists in the regular suc- 
cession of colors — from blue to violet, pink, and red, the last 
continuing for some time, and ultimately changing to a dirty 
green. So far as is known at present, strychnia is the only 
substance that answers to the above requisition. There are 
others that react somewhat similarly, which will be noticed 
hereafter. 

The exceeding delicacy of the color-test deserves special 
notice. If the strychnia be perfectly pure, and the manipu- 
lation be properly performed, so minute a quantity as the 
one-millionth of a grain can be detected, as we have repeat- 
edly verified In our own experience, and as Is corroborated 
by other experimenters. It depends altogether on the 
delicacy of the experiment. These minute quantities of 
strychnia are best obtained by first making a solution of the 
alkaloid in pure water, with the addition of acetic acid, of a 
definite strength. This may readily be reduced by the 
addition of more water. Fractional portions of the solution 
may be obtained by using a pipette drawn out to a capillary 
point, which will deposit minute droplets on a warmed, 
clean porcelain surface. The object here is to concentrate 
the quantity to be experimented upon into as small a space 
as possible. The drop should then be evaporated to dryness 
spontaneously. A small drop of pure concentrated sul- 
phuric acid is then applied to the deposit, by means of a 
finely-pointed glass rod, and then a minute crystal of the 



STRYCHNIA THE COLOR TEST 363 

bichromate of potassium (or one of the other oxidizing 
bodies) is placed alongside of the acid solution, and then, by 
means of the rod, is drawn through the solution and gently 
stirred in it. 

Interferences. — As above mentioned, the color-test, pro- 
perly applied, will detect exceedingly minute portions of 
pure strychnia, but there are many organic substances 
whose presence will considerably modify and even com- 
pletely disguise this test This fact has been known to 
chemists since 1850, when it was first announced by Brieger 
{Chem. Gaz.^ VIII, p. 408). His results have been con- 
firmed, and the list of interfering bodies has been extended 
by subsequent experimenters. According to Lyman (TV". Y. 
Med. Gaz., Mar., 1871), perm.anganate of potassium is the 
only reagent that will develop the color-test with strychnia, 
when the latter is mixed with either morphia or quinia in 
excess. The most important of these interferences, con- 
sidered medico-legally, is probably morphia, inasmuch as 
this substance might be likely to be given to allay the 
severity of the strychnia spasms, and would consequently be 
associated with the strychnia extracted from the body after 
death. A large number of experiments made by the author 
(Am. Jour. Med. Sd., Oct., 1861, and April, 1862) clearly 
confirm the fact of the interference of morphia with the 
usual color-test for strychnia, both in the pure state and 
when mixed with organic matters. One experiment only 
will here be mentioned : A small cat was poisoned " with 
one-twentieth of a grain of strychnia and one-tenth of a 
grain of morphia. The ultimate extract obtained from the 
stomach by Stas' process entirely failed to yield the color- 
test, although the bitterness of the extract, and the fact that 
its solution produced the characteristic tetanic convulsions 
in a number of frogs, distinctly proved its existence." 



364 TOXICOLOGY. 

Admitting, then, \\\^fact of these interferences, it is well to 
remember that, practically, they may be avoided, in a medico- 
legal investigation, by the employment of chloroform in- 
stead of ether, as the solvent to extract the strychnia from 
organic mixtures, — morphia and other interfering substances 
being insoluble in this menstruum. 

Fallacies. — Exception has been taken to the color-test, on 
the ground that other substances besides strychnia will 
yield colors similar, if not identical, when similarly treated ; 
but a careful attention will readily avoid all difficulty. The 
substances alluded to are ciwaidne, veratrine, cod-liver oil, 
salicine, santonine, aniline, pyroxaiithine, narceine, papaverine 
and solanine ; but in relation to most of these, a radical ground 
of distinction is that they are colored by sulphuric acid alone, 
which is not the case with strychnia. A salt of aniline is 
not colored by the acid alone, but only in the presence of 
one of the above mentioned oxidizing bodies; but there is 
this difference between it and strychnia : the former is first 
colored green, then a very persistent blue, and finally black. 

Curarine has many points of resemblance to strychnia ; it 
is very bitter; it yields a succession of colors with sulphuric 
acid and bichromate of potassium; but it is colored by sul- 
phuric acid alone ; it is nearly insoluble in chloroform, and 
readily soluble in potash. Its physiological effects are the 
opposite of those of strychnia. 

Cod-liver oil, when treated with sulphuric acid alone, 
affords a play of colors somewhat like those presented by 
strychnia. 

2. The galvanic test of Dr. Letherby acts on the same 
principle, of presenting nascent oxygen to the strychnia ; 
but in this instance it is evolved by galvanism. A drop of 
a dilute solution of strychnia is placed in a small depression 
made on platinum foil, or in a platinum capsule, allowed to 



POISONING BY STRYCHNIA TESTS. 365 

evaporate to dryness, and then moistened with a drop of 
sulphuric acid. The foil (or capsule) is connected with the 
positive pole of a single cell of Grove's battery, and the acid 
is touched with the platinum terminal from the negative 
pole. Instantly, the violet color will flash out on the metal, 
and on removing the pole from the acid, the tint will remain. 

3. Potassa and ammonia precipitate the alkaloid from a 
somewhat concentrated solution, in the crystalline form. 
The best method is to expose a drop of the solution on a 
glass slide, to the vapors of ammonia, and place it under 
the microscope ; the beautiful formation of the long stellate 
prismatic crystals can easily be distinguished ; these can be 
identified by touching them^ with a drop of sulphuric acid 
and a fragment of bichromate of potassium, when the play 
of colors will take place. 

4. Bichromate of potassium. — A solution of this salt 
throws down from a strychnia solution a bright yellow pre- 
cipitate, which soon becomes crystalline. Placed under the 
microscope, these crystals appear in groups, mingled with 
octahedral plates. When dried, these should be verified 
by touching them with a drop of sulphuric acid. This is a 
satisfactory test. 

5. Carbazotic (or picric) acid. — A solution of this acid 
precipitates strychnia from its solution in the form of 
abundant yellow crystals. The best mode of showing it is 
to add a drop of the solution to one of strychnia, on a glass 
slide, and view the reaction under the microscope. The pre- 
cipitate which first forms soon assumes the appearance of tufts 
of yellow crystals, of a peculiar claw-like form. These, as 
in the former experiment, may be subjected to the color- 
test, by the same method. 

Besides the above tests, there are others of inferior value 
— as corrosive sublimate, ferrocyanide of potassium, bichlorate 



366 TOXICOLOGY. 

of platininn^ iodated iodide of potassium, and sidpho-cya7iide of 
potassium. 

Tardieu considers chlorine gas to be a very delicate test 
for strychnia. When a small stream of this gas is slowly 
passed through a dilute solution of strychnia, each bubble 
of the gas becomes surrounded by a white film, and ulti- 
mately, quite a copious, white amorphous deposit takes 
place, which is soluble in ammonia. According to the 
above authority, no other alkaloid gives this reaction with 
chlorine. 

The physiological or frog test. — The extreme susceptibility 
of the frog to the action of strychnia was first employed 
by Dr. Marshall Hall, as a test for this poison. It may be 
applied either by immersing a small frog in the strychnia 
solution, or else injecting it either into the throat of the 
animal, or preferably, under the skin. We have repeatedly 
resorted to this test, and uniformly with satisfactory results. 
One of these experiments demonstrates very clearly the ex- 
treme susceptibility of the frog to the influence of strychnia. 
*' The one five-hundredth of a grain of strychnia was put into 
the throat of a middling-sized frog; it was convulsed and 
died in about thirty minutes. The extract obtained from 
the stomach by Stas' process, although it afforded no per- 
ceptible color-test, had a bitterish taste, and produced 
tetanic spasms in several small active frogs." 

Our experiments in this line further demonstrate the fact 
that while morphia, when present in excess, with strychnia 
in small quantities, has the power to disguise the color-test, 
it affords no obstacle to the employment of the frog-test. Two 
experiments only will be quoted under this head : " A frog 
weighing thirty-five grains was immersed in a solution con- 
taining one grain of strychnia and thirty-two grains of mor- 
phia in six pints of water ; it was convulsed in twenty 



STRYCHNIA TOXICOLOGICAL EXAMINATION. 367 

minutes. Another animal, rather smaller, was convulsed in 
five minutes." (In these experiments only a small portion 
of the solution was used — less than a fluid drachm — put 
into a conical glass, in which the hind-quarters only of the 
animal were immersed). " A cat was poisoned with one- 
twentieth of a grain of strychnia and one-tenth of a grain of 
morphia. The stomach, on examination by Stas' process, 
failed to yield the color-test ; but the watery solution of the 
extract produced most decided tetanic convulsions in eight 
frogs, generally resulting in death." 

Toxicologicalexaniiiiatio7i. — The stomach properly divided, 
together with its contents, and a sufficient quantity of dis- 
tilled water, should be made distinctly acid with acetic acid. 
If the elaborate process of M. Stas is to be employed, the 
strongest alcohol must be used instead of water. In either 
case, the mass should be digested on a water-bath for several 
hours. A high temperature is objectionable, as it dissolves 
out the starchy matters. After cooling, it is strained through 
muslin, and the solid matters washed with dilute alcohol and 
pressed. The liquid should next be concentrated by evapo- 
ration, and filtered through paper. It should now be 
evaporated to dryness. The residue will contain any 
strychinia usually present in the form of acetate, mixed with 
organic matter. This residue should now be thoroughly 
mixed with a small quantity of distilled water containing a 
few drops of acetic acid, then filtered through paper, and the 
filtrate poured into a glass tube or flask, and an excess of 
solution of potassa or soda (or ammonia) added, which 
liberates the strychnia from its combination. Pure chloro- 
form, slightly in excess of the mixture, is now added, and the 
whole briskly shaken together for some minutes. The 
chloroform dissolves out the alkaloid, and from its gravity 
settles to the bottom of the mixture, after the lapse of some 
time. 



368 TOXICOLOGY. 

In order to separate the chloroform from the supernatant 
liquid, we have found that the easiest practical method is to 
transfer the whole mixture to a stoppered glass funnel, or 
what answers equally well, a glass syringe of proper size, 
after removing the piston, and having previously contracted 
the nozzle to a fine point by means of the flame. Before 
introducing the liquid, this small aperture should be plugged 
with a splinter of wood, and about half a drachm of pure 
chloroform first poured into the syringe, so as to about fill 
the narrow portion. The mixture is now to be carefully 
poured in, and a sufficient time allowed to elapse for the 
chloroform to separate and settle to the bottom. 

By placing the thumb over the larger aperture of the 
syringe, and withdrawing the wooden plug, it will be very 
easy to control the flow of the contents. A few drops may 
be allowed to fall successively, as each one dries, into a 
warmed watch glass, or porcelain capsule, for a trial test, by 
means of sulphuric acid and bichromate of potassium {vid. 
p. 361). The whole of the chloroform is then permitted to 
flow out into one or more capsules, or watch glasses, great 
care being taken not to allow any of the other mixture to 
escape along with it. The remaining alkaline liquid may 
be shaken up with an additional portion of chloroform, and 
the separation again made as before. All the chloroform is 
now permitted to evaporate spontaneously to dryness. The 
contained strychnia, if of notable quantity, will be found in 
the deposit, in an amorphous — not crystalline — form, ac- 
cording to our experience. 

A portion of this extract should now be examined by the 
taste, for bitterness ; by the color-test (although this may not 
be very satisfactory, on account of the mixture with organic 
matter) ; and by the frog-test. The remaining portion of 
the extract is to be dissolved in a minute quantity of water, 



STRYCHNIA— DETECTION IN THE TISSUES. 369 

acidulated with acetic acid, filtered, and subjected to the 
usual tests (yid. p. 361). 

The main difficulty in conducting this experiment arises 
from the presence of organic matters in connection with the 
strychnia. If the chloroform extract has a yellow color 
(denoting its impurity), a few drops of strong sulphuric acid 
should be added to it and thoroughly stirred with a glass 
rod. This destroys and carbonizes all the organic matter, 
but merely converts the strychnia into a sulphate ; add a 
few drops of water. After standing a short time, the dark 
liquid is filtered, solution of potassa is added in excess, then 
pure chloroform, as explained above. The second extract 
thus procured is generally sufficiently pure for all practical 
purposes. 

It not unfrequently happens, when operating on complex 
organic mixtures by the chloroform process, that difficulty 
is experienced in getting the chloroform to separate from 
the alkaline solution; the whole mass forming a sort of 
emulsion. In such a case, the tube may be immersed in hot 
water for some time ; and if this does not answer, nothing 
remains but to agitate the mixture several times successively 
with about half its volume of pure water, allowing it to rest 
each time, and separating the chloroform as before directed. 
The method of dialysis has been recommended by some 
authorities, but we do not consider it as exhaustive and re- 
liable as the one just described. 

Detection in the tissues and blood. — Strychnia is absorbed 
into the circulation, and deposited in the various organs, just 
like the mineral poisons. The rapidity with which the ab- 
sorption takes place is shown in a case mentioned by Taylor, 
where a man took five grains of the poison by mistake, and 
died in half an hour. Strychnia was discovered in the 
stomach in the quantity of one grain; it was also detected 
17 



370 TOXICOLOGY. 

in the liver and the tongue. This case shows that within 
half an hour, four-fifths of the poison had been removed from 
the stomach (or could not be detected there by chemical re- 
search), and had been diffused throughout the body. There 
are, however, other cases, where the circumstances were 
apparently just as favorable for the absorption and diffusion 
of the poison, but where there was a total failure to detect 
it in the organs, after death. 

The process is the following : the organs are to be finely 
crushed and digested in strong alcohol, acidulated with sul- 
phuric acid, in the proportion of eight drops to the fluid 
ounce of the mixture; this should be heated below 212° F. 
for about an hour; when cool, it is to be filtered and con- 
centrated, as before directed. The residue is then nearly 
neutralized by liquor potassse, care being taken to maintain an 
acid reaction, then filtered, and evaporated nearly to dryness. 
To the cooled residue a drachm or two of strong alcohol is 
added, and thoroughly stirred with it ; this dissolves out the 
sulphate of strychnia, and leaves the sulphate of potassium 
and the organic matters. The alcoholic solution is now 
filtered, evaporated almost to dryness, the residue stirred 
with pure water, rendered alkaline by potassa, and finally 
agitated with chloroform, which deposits the alkaloid, if 
present, on evaporation. 

Dr. Taylor recommends acetic, instead of sulphuric, acid; 
and ammonia instead of potassa, in these cases. 

The method of Rodgers and Girdwood is somewhat sim- 
ilar, and they employ hydrochloric acid and ammonia as the 
reagents, along with chloroform. 

Strychnia may be recovered from the blood by a similar 
process. In some experiments of Dr. Wormley, he detected 
the poison in the blood of dogs and cats, where death took 
place in three and six minutes respectively after its admin- 



POISONING BY BRUCIA. 371 

Istration. This shows the extreme rapidity with which it 
is absorbed. 

Detection in the urine. — The urine should be evaporated 
to a syrupy consistence, acidulated with acetic acid, mixed 
with an ounce of strong alcohol, filtered, and evaporated to 
near dryness. The residue is to be stirred with pure water, 
filtered, if necessary, liquor potassse added in excess, and 
agitated with chloroform. 

Failure to detect. — It must be admitted that the most care- 
ful analysis sometimes fails to discover this poison in the 
body after death, and that, too, where the circumstances 
were apparently favorable to it. This failure may sometimes 
be ascribed to the smallness of the dose, and again, possibly, 
to some interference not well understood. M.^x^ putrefaction 
of the body is no obstacle to its detection, since it has been 
recovered months after death, and where the body was in an 
advanced state of decomposition. Christison, Taylor and 
other well-known authorities have at times been foiled in 
their efforts. In a case that occurred to the author, some 
years ago, when a woman was poisoned (as was alleged) 
with six grains of strychnia, and where death was postponed 
for the unusually long period of six hours, there was a sim- 
ilar failure to detect the poison eight weeks after death, al- 
though the body was well preserved. 

Brucia. — This alkaloid is generally found associated with 
strychnia. It occurs either in the form of a white powder, 
or in colorless prismatic crystals. It is more soluble in 
water and alcohol than strychnia. It is freely soluble in 
chloroform and alcohol. It has an intensely bitter taste. 
Concentrated sulphuric acid dissolves it, giving a faint rose 
coloration. Nitric acid gives a characteristic blood-red 
color. 



372 TOXICOLOGY. 

Its poisonous properties are similar to those of strychnia, 
though less intense. As the symptoms of poisoning by 
brucia are similar to those caused by strychnia, the toxi- 
cologist should guard against being deceived in a medico- 
legal investigation, in the event of not discovering strychnia 
by the usual color test. In such a case, it would always be 
proper to search for brucia. 

Tests. — The characteristic reagent is nitric acid, which 
instantly produces a blood-red color, with a speedy solution 
of the alkaloid. If heated, the color changes to yellow. 
If, after cooling, a drop of the solution of protochloride of 
tin be added, the color changes to a beautiful purple. The 
somewhat similar red color produced on morphia by nitric 
acid is not changed by protochloride of tin. 

(2) Stdphuric acid and nitrate of potassium. — Touch the 
fragment of brucia with a drop of strong sulphuric acid, a 
faint rose color is produced ; then add a small crystal of 
nitre, when the color changes to a deep orange-red. 

(3) Ammonia produces, with a drop of brucia-solution, a 
beautiful crystallization, viewed by the microscope. Other 
tests of less importance are sidpho-cyanide of potassium, 
bichloride of platinum and corrosive sublimate, 

Th.Q frog-test is equally applicable to brucia, allowing for 
its comparative inferiority in strength to strychnia. 

The toxicological examination for brucia is conducted in 
the same manner as described for strychnia. The ultimate 
extract is to be tested by nitric acid and protochloride of 
tin. Brucia has been detected in the blood of animals 
poisoned by it. 



< 



POISONING BY BELLADONNA. 373 



CHAPTER XXVIIL 

ORDER III.— CEREBRO-SPINAL NEUROTICS. 
(i) DELIRIANTS. 

This subdivision of Cerebro-spinal Neurotics has received 
the name of Deliriants, because of the active dehrium that 
constitutes one of their prominent symptoms. They also 
produce other effects in common, such as illusion of the 
senses, dilatation of the pupil, heat and dryness of the 
throat, a flushed face, and frequently a redness of the skin. 
They all belong to the same natural order of plants. Sola- 
7iace(B. From their physiological property of dilating the 
pupil, they have received the name of Mydriatics. They 
comprise Belladonna, Stramonium, Hyoscyamus, and dif- 
ferent species of Solanum. 

SECTION I. 

POISONING BY BELLADONNA— ATROPIA. 

SYMPTOMS. — ATROPIA. — FATAL DOSE. — TREATMENT. — POST-MORTEM 
APPEARANCES. — CHEMICAL ANALYSIS. — TOXICOLOGICAL EXAMINA- 
TION. 

Belladonna {Deadly Nightshade). — The leaves, berries 
and root of Atropa Belladonna are violently poisonous. The 
leaves and root are used in medicine. Children are fre- 
quently poisoned by eating the berries. 

Symptoms.— K sense of heat and dryness in the mouth 
and throat, difficulty of swallowing, nausea, vomiting, giddi- 
ness, extreme dilatation of the pupil, loss of vision, flushed 
face, sparkling eyes, delirium of an excited, maniacal char- 



374 TOXICOLOGY. 

acter, spectral illusions, convulsions, followed by stupor and 
coma. Irritation of the urinary organs frequently occurs, such 
as strangury, suppression of urine and hsematuria. A scarlet 
eruption is often observed over the skin. Some of these 
effects have been produced by the external application of 
belladonna, in the form of a plaster or liniment. The 
symptoms of belladonna-poisoning usually show themselves 
from half an hour to two hours, occasionally sooner. They 
do not generally terminate fatally. Death, when it occurs, 
usually takes place within twenty-four hours. 

In case of death from the leaves or seeds of belladonna, 
these can usually be distinguished in the alimentary canal, 
by their botanical characters. 

Atropia. — This alkaloid is the active principle of bella- 
donna, and is a very active poison, producing symptoms 
similar to those above described, only more speedily. The 
application of a weak solution to the eyes has occasioned 
symptoms of belladonna-poisoning. Used hypodermically, 
even in doses of one-fiftieth to one-tenth of a grain, it occa- 
sions, at times, violent symptoms. Employed in this man- 
ner in combination with morphia in excess, its activity 
appears to be modified. Death has resulted from the ex- 
ternal use of a strong ointment of atropia. 

Fatal dose. — One-half to three-quarters of a grain may be 
regarded as a minimum fatal dose for an adult. The crim- 
inal administration of this poison is veiy rare. Dr. Taylor 
records a case where a surgeon of a workhouse was fatally 
poisoned by a nurse, by administering it in milk. The 
diagnosis is not always easy, since the same symptoms are 
produced by hyoscyamus and stramonium. There appears, 
to be a special tendency to its elimination from the system 
by the kidneys. Prof Guy states, on the authority of Dr. 
John Harley, that the presence of atropia in the urine can 



ATROPIA TESTS. 375 

be readily proven within twenty minutes after the injection 
under the skin of one-forty-eighth to one-ninety-sixth of a 
grain, by the action of the urine on the eye. Twelve drops 
will largely dilate the pupil, and maintain it in that state 
for several hours (Foren. Med., p. 512). 

Treatment. — The immediate evacuation of the stomach 
by an active emetic, or by the stomach-pump. There is no 
chemical antidote. The physiological antidote is 7norphia, 
which should be carefully and repeatedly administered {vid. 
ante p. 334). 

Post-mortem- appearances. — These are not characteristic. 
There may be congestion of the vessels of the brain, with 
some red patches of the stomach and oesophagus. When 
the poisoning has resulted from eating the ripe berries, the 
whole lining membrane of the alimentary canal may be 
dyed of a purple color, and portions of the berries and seeds 
may be discovered in the intestines, or in the stools. The 
blood is usually fluid, and dark-colored. 

Chemical analysis. — Atropia, when pure, occurs in white 
crystalline tufts. Its taste is acrid and bitter ; slightly 
soluble in cold water, very soluble in alcohol, ether and 
chloroform. It sublimes at 200° F. Its color is not 
changed by either of the mineral acids. It has alkaline 
properties, neutralizing acids, and forming salts. 

The alkalies throw down a precipitate from a salt of 
atropia, which ultimately becomes crystalline. That pro- 
duced by ammonia remains amorphous. It is also precipi- 
tated by chloride of gold, and by carbazotic acid. Wormley 
considers bromine in hydrobromic acid to be the character- 
istic test for atropia. The precipitate is at first amorphous, 
of a yellow color ; but it soon becomes crystalline. It is 
insoluble in acetic acid, and but slightly so in either of the 
mineral acids. The one-ten-thousandth, to one-twenty-five 



376 ■ TOXICOLOGY. 

thousandth of a grain will give satisfactory results with this 
reagent {Micro- Chem. of Poisons, p. 631). 

Toxicological examination. — ^We should first of all en- 
deavor to discover any seeds, or remains of the leaves or 
berries of the plant. The vomit and stools should, if 
possible, be also examined for these. The stomach, with 
its contents, and other organs, properly comminuted, should 
be treated after a modification of Stas' process, alcohol 
being used as the solvent, along with sulphuric acid. After 
heating, straining, evaporating, purifying by pure ether, re- 
moving the ether, and adding solution of potassa in excess, 
the ultimate extract is obtained by chloroform and tested, 
first, with the bromine-test, which, if successful, may be 
followed by the other tests. 

The physiological test consists in applying a portion of the 
ultimate extract to the eyes either of a man, or one of the 
lower animals, as the rabbit. The minutest quantity will 
produce the characteristic dilatation of the pupil. It must, 
however, be remembered that other members of this class 
of vegetables will produce a similar result. 

The rabbit evinces a remarkable tolerance for belladonna 
and its alkaloid. It will live exclusively on the former for 
many days, and tolerate enormous doses of the latter, either 
by the stomach or subcutaneously, without perceptible 
effects. 

SECTION II. 
POISONING BY STRAMONIUM, HYOSCYAMUS AND SOLANUM. 

Stramonium (Thorn Apple, Jamestozvn Weed). — The Da- 
tura stramonium is a very common plant, abounding in this 
country, and also in Europe. It grows freely on waste 
grounds ; other varieties occur in India. All parts of the 
plant are poisonous, especially the seeds and fruit. Its 
active alkaloid principle is named daturia. 



POISONING BY HYOSCYAMUS. 377 

Cases of poisoning by stramonium are usually accidental, 
and chiefly occur in children, from eating the seeds. 

Symptoms. — Very similar to those produced by bella- 
donna, such as dryness of throat, with difficulty of swal- 
lowing, dilated, insensible pupil, violent and incoherent 
delirium, nausea, vomiting, headache, vertigo, ringing in 
the ears, spectral illusions, followed by stupor and coma. 
Sometimes there are convulsions and paralysis, together 
with a scarlet efflorescence on the skin. The external appli- 
cation of the bruised leaves has occasioned symptoms of 
poisoning. 

In India, the Datura is employed by the Thugs for the 
purpose of drugging their victims. 

Post-mortem appearances. — Very similar to those result- 
ing from belladonna. There is nothing characteristic. The 
seeds and remains of the leaves may be discovered in the 
alimentary canal, if these have been the cause of death. 

Treatment. — The same as that recommended for bella- 
donna poisoning. 

Analysis. — The seeds are of a black or brown color, 
kidney-shaped, with a wrinkled surface. They are much 
larger than those of belladonna or hyoscyamus. According 
to Prof Guy, it requires one hundred and twenty henbane 
seeds, and ninety of belladonna to weigh one grain, but only 
eight of stramonium. There is no known test to distinguish 
daturia from atropia ; these two alkaloids are now generally 
regarded as identical. 

The method of procuring daturia from the stomach and 
organs is the same as that above described for atropia 
(P- 332). 

Hyoscyamus {Henbane). — The Hyoscyaimis niger grows 
both in America and Europe. All parts are poisonous. 

• 17* 



378 TOXICOLOGY. 

The root is tapering, resembling that of the parsnip, for 
which it has often been mistaken. The medicinal prepara- 
tions from the plant are extremely variable and uncertain, 
depending very much on the mode of growth, collection 
and preparation. 

The symptoms, in general, resemble those of belladonna 
and stramonium. 

Analysis. — It can only be identified in the matters vomited, 
or in the stomach and intestines after death, by the 
botanical characters of the seeds or fragments of the leaves 
discovered. 

Hyoscyamia, the active alkaloidal principle, occurs in 
white, silky crystals, inodorous when pure, but as usually 
found, possessing a disagreeable smell ; taste acrid. It is 
difficult to isolate. There is no proper chemical test for it. 
It dilates the pupil, like atropia and daturia. It speedily 
passes into the urine, when swallowed. 

SoLANUM. — Three species of the genus Solanum are 
usually referred to in the books, as possessing poisonous 
properties : these are vS. dulcamara, or Bittersweet, or 
Woody Nightshade; .S. 7iigrum, or Garden Nightshade; 
and 5. tuberosum, or common potato. These all contain an 
active alkaloid principle — Solania. 

The 5. dulcamara is a native of Great Britain, and is cul- 
tivated in our gardens as an ornament, for its purple flowers 
and bright red berries. The latter are frequently eaten by 
children, occasioning poisonous results. The dried stems 
are used medicinally. 

The S. nigrum produces white flowers and black berries. 
The latter, like the fruit of the S. dulcamara, have frequently 
proved poisonous to children who have swallowed them. 
They are more powerful in their effects than the others. 



POISONING BY SOLANIA. 379 

6". tuberosum, or common potato. — The berries and young 
shoots have proved poisonous, the former fatally, in the case 
of a young girl reported in the Lancet, June, 1858. Chris- 
tison quotes from Dr. Kabler, of Prague, an instance where 
four persons of a family were seized with alarming symp- 
toms, such as vomiting, coma and convulsions, after eating 
potatoes that had commenced to sprout and shrivel. 

The general symptoms produced by solania are very 
similar to those resulting from the other mydriatics. It is 
much less powerful than the other alkaloids of this class. 

When pure, solania is in the form of delicate acicular 
crystals ; nearly insoluble in water, soluble in alcohol, less 
so in ether, insoluble in chloroform. It is also soluble in 
amylic alcohol. Cold sulphuric acid first changes it to an 
orange-yellow, and then dissolves it, the solution becoming 
brown. Nitric acid dissolves it, the solution being at first 
colorless, and subsequently changing to a rose-red tint. 
The former acid is the best test for it. Other reagents do 
not give characteristic results. 

Solania is separated from organic mixtures by a modifica- 
tion of Stas' process ; alcohol and sulphuric acid being em- 
ployed as the solvent, and warm alcohol to separate the 
final extract. 



380 TOXICOLOGY. 



CHAPTER XXIX. 

(3) DEPRESSANTS. 

Under this subdivision of Cerebro-spinal Neurotics, are 
conveniently included several active poisons, which agree 
in the property of causing great depression of the muscular 
system, although In some other respects they may differ 
from one another. By thus grouping them together, it is 
not intended to imply that they all produce the same phy- 
siological effects. 

SECTION I. 
POISONING BY TOBACCO AND LOBELIA. 

EFFECTS OF TOBACCO — POST-MORTEM LESIONS — NICOTINA — PROPER- 
TIES — CHEMICAL REACTIONS — TOXICOLOGICAL EXAMINATION — 
LOBELIA. 

Tobacco. — The dried leaves of Nicotiana tabacimi, a plant 
belonging to the natural order of Solanacece. It owes its 
activity and poisonous properties to a volatile, liquid alka- 
loid, of an oily consistence, named nicotina^ which some- 
what resembles conia, and which exists in different propor- 
tions in different specimens of the leaves, varying from two 
to eight per cent. 

Symptoms. — A large dose of tobacco (or even a small 
one to those unaccustomed to Its use) produces very decided 
symptoms. Very soon after taking It, either by swallowing 
or by enema, it occasions nausea, giddiness, a sense of con- 
fusion of the head, vomiting, severe retching, great prostra- 
tion, heat In the stomach, frequent and very feeble pulse, 
cold, clammy skin, trembling of the limbs, and sometimes 
severe purging. Respiration is difficult, and urination invol- 



POISONING BY TOBACCO. 381 

untary. In some cases, there is violent pain in the abdo- 
men ; in others, there is great sense of depression, and of 
impending death. The pupils are not always similarly 
affected. Taylor states that they are dilated. Percival 
speaks of it as differing from belladonna in contracting 
them; also by the absence of delirium, and of dryness of the 
throat. Wharton and Stille {Med. Jurisp., 1873, II, p. 609) 
state that the pupils are but slightly affected. 

The external application of tobacco, either to the sound 
skin, or to abraded surfaces, produces alarming, and even 
fatal effects. A wet leaf put around the throat in spasmodic 
croup often relieves the spasm, but it should be used with 
great caution on a young child. A decoction applied to the 
skin of a man for an eruptive disease, caused death in three 
hours {Am. Jour. Med. Sci., January, 1865). 

Its fatal effects, when administered by the rectum, are 
well known. It was formerly much used in this manner, 
to aid the taxis in strangulated hernia ; but it is always a 
dangerous remedy. Even tobacco smoke, diffused through 
water and swallowed, has caused the death of a young 
infant. 

Tobacco smoking has been known to produce violent and 
even fatal effects, when carried to great excess, although 
there is considerable diversity of opinion as to whether 
nicotin is present in tobacco smoke, or not. Respectable 
authorities are found on both sides. 

The rapidity of the effects of tobacco on the human 
system varies with the dose, and mode of administration. 
In one case, snuff swallowed in whiskey caused death in 
one hour. In another instance, quoted by Beck, an enema 
of tobacco, used to expel worms, produced violent convul- 
sions and death m fifteen minutes. Christison gives another 
case, where a tobacco enema proved fatal in thirty-five 



382 TOXICOLOGY. 

minutes. The application of nicotina to the tongue of an 
animal caused death zvithin two ininittes. 

Post-mortem appearances, — There is no characteristic 
lesion. A diffused redness over the mucous surface of the 
stomach and bowels, with an empty heart, and congestion 
of the vessels of the brain, liver and lungs, are about all 
that will be found. The blood is usually very dark and 
liquid. If the leaf or powder has been swallowed, these 
may be recognized by microscopic examination. In a case 
of suicidal death, examined by Dr. Taylor, there were gen- 
eral relaxation of the muscular system, staring eyes, bloated 
and livid features, the vessels of the brain and scalp, and 
also of the lungs, gorged with black blood, and the heart 
empty, except its left auricle. There was intense conges- 
tion of the mucous membrane of the stomach and of the 
liver. The blood was black and liquid, and in some parts 
had the consistence of treacle. No peculiar odor was per- 
ceptible (On Poisons, p. 66 1). 

Nicotina. — This alkaloid, when pure, is a colorless, oily 
liquid, which, on exposure, becomes light yellowish, and 
thicker in consistence. It produces a greasy, volatile stain 
on paper, like conia. It is usually said to possess an acrid, 
unpleasant odor, but, if perfectly pure, the smell is ethereal 
and agreeable. It has a strong, alkaline reaction, and a 
density of 1.048. It is freely soluble in water, alcohol, 
ether, chloroform, turpentine, and the fixed oils. Ether and 
chloroform will extract it from its watery solution. Its taste 
is very pungent and acrid, even when much diluted, causing 
a peculiar sensation in the throat and air passages. It 
slowly distills at about 295° F., and boils at about 470° F. 
Heated on platinum, it burns with a bright flame, emitting 
a thick black smoke. - 

Nicotina is one of the most rapidly fatal poisons known, 



NICOTINA CHEMICAL REACTIONS. . 383 

even rivaling prussic acid. A single drop destroyed a rabbit 
in three and a half minutes. In Wormley's experiments, 
one drop, placed in the mouth of a full-grown cat, produced 
immediate prostration, continued convulsions, and death in 
seventy-eight seconds. 

In the celebrated case of Cotmt Bocarme, who was exe- 
cuted in Belgium, in 185 i, for poisoning his brother-in-law, 
Gustave Fougnies, nicotina was the agent used. An un- 
known quantity was forcibly put into the throat of the 
victim, the Countess assisting her husband as an accomplice 
in the murder. Death was believed to have taken place 
within five minutes. The poison was detected by M. Stas 
in the tongue, throat, stomach, liver and spleen of the 
deceased, and also from stains on the floor, near where the 
act was committed. From the excellent report of the ex- 
amination of M. Stas, we may note the following particulars : 
The appearance of the tongue indicated the action of some 
highly acrid agent ; it was swollen, blackened, softened and 
friable; the epithelium was easily detached. This was also 
the condition of the mucous lining of the mouth and 
pharynx ; it was reddened, as if cauterized, and easily sepa- 
rated. The lining membrane of the stomach was intensely 
injected, exhibiting large patches, which were livid and 
black. The vessels were filled with a black coagulum, 
resembling blood that had been treated with sulphuric acid. 
The duodenum was also highly injected. There were no 
ulcerations or perforations of the stomach and bowels. The 
lungs were gorged with black blood, and exhibited the usual 
character of asphyxia. The heart was normal, its cavities 
contained black, liquid blood. No odor was observed in the 
body (Orjila, Toxicol.^ II, p. 498). 

Chemical reactions. — If a drop be put into a watch glass, 
and this be covered with another glass, inverted, containing 



381 TOXICOLOGY. 

a drop of either nitric or hydrochloric acid, the glass will 
become filled with white fumes, not so dense as from conia, 
nor do they give rise to the formation of crystals. The 
strong acids applied directly to it produce no characteristic 
effects. 

Nicotina unites freely with acids, forming salts, which 
retain the peculiar taste of the alkaloid, but are destitute of 
odor. They are mostly soluble in water and alcohol, but 
not in ether or chloroform. 

(i) Bichloride of platinum throws down a yellow precipi- 
tate, which becomes crystalline, seen under the microscope, 
which is soluble in hydrochloric acid. (No precipitate is 
caused by conia.) 

(2) Corrosive sublimate gives a white crystalline precipi- 
tate, changing to yellow. These crystals assume a peculiar, 
beautiful appearance, in groups of various patterns. These 
are distinguished from the precipitates caused by this same 
reagent with ammonia and the other alkaloids, by the fact 
that the latter are amorphous, except that of strychnia, but 
which last is wholly unlike that produced by nicotina. This 
is a very delicate test. 

(3) Terchloride of gold yields a yellow amorphous pre- 
cipitate, but not characteristic. The same is true of iodide 
of potassium, and of bromine in hydrobrojnic acid. 

(4) Carbazotic acid gives a yellow, amorphous precipitate, 
which ultimately assumes the form of a crystalline tuft, to be 
viewed by the microscope. 

To xico logical examination. — The stomach and other organs, 
properly prepared, may be subjected to the process of Stas. 
In fact, it was the very process employed by its originator 
in the Bocarme case above alluded to. Other good authori- 
ties have somewhat simplified his process. Water may be 
employed as the solvent, instead of alcohol; and either 



FOTSONING BY LOBELIA SYMPTOMS. 385 

acetic, sulphuric, or tartaric acid may be used. After proper 
concentration and filtration, it should be supersaturated 
with potash or soda, and shaken up with chloroform or 
ether, and these solutions, when properly separated, allowed 
to evaporate spontaneously on watch crystals, when the 
nicotina, if present, will be seen in the form of drops or 
oily streaks, having the peculiar odor of the alkaloid, which 
is rendered more distinct by heating. This should be dis- 
solved in a few drops of water, and the appropriate tests 
applied. A drop or two may also be given to a small 
animal. Nicotina inserted under the skin of a frog pro- 
duces peculiar muscular movements, slowing of the heart's 
action and of respiration. 

Lobelia. — The Lobelia inflata, or Indian tobacco, is a 
native of this country, belonging to the natural order 
LobeliacecB. It is extensively used both here and in Great 
Britain as the standard remedy of the Thoinsonian or Botani- 
cal Doctors. According to Dr. Letheby, thirteen cases of 
poisoning by this substance had occurred in England within 
three or four years, and Dr. Beck states that " thousands of 
individuals in the United States have been murdered by the 
combined use of capsicum and lobelia, administered by 
the Thomsonian quacks" {Med. Jurisp.^ II, p. 736). The 
leaves and seeds are the parts employed. They owe their 
activity to a fixed alkaloid named lobelina. 

Symptoms. — In small doses lobelia acts as an expectorant ; 
in large doses, as an emetic and depressant. In poisonous 
doses it produces distressing nausea and vomiting, some- 
times purging, extreme relaxation, cold sweats, small, feeble 
pulse, great prostration, contracted pupils, stupor, occasion- 
ally convulsions, coma and death — symptoms strikingly like 



386 TOXICOLOGY. 

those caused by tobacco. A drachm of the powdered 
leaves has proved fatal. 

The post-mortem appearances are very similar to those 
caused by tobacco. 

Lobelina, the active alkaloid principle, is a yellowish 
liquid, lighter than water, of a somewhat aromatic odor, and 
acrid, persistent taste ; soluble in water, more so in alcohol 
and ether ; has an alkaline reaction, forming soluble salts, 
with acids. Tannic acid precipitates it from its solutions. 
It resembles nicotina in most of its properties. On animals, 
lobelina seems to produce the narcotic, but not the emetic 
effects of the plant. 

No case is recorded of death from lobelina. In the in- 
vestigation of a case of death from lobelia, the diagnosis 
would be materially aided by the discovery of fragments of 
the leaves, or of the seeds. (For the report of two interest- 
ing trials for fatal poisoning by lobelia, under the ''botanical 
treatment," see Wharton & Stille's Med.Jurisp.^ 1873, II, pp. 
586 and 963.) 

SECTION II. 
POISONING BY HEMLOCK— CONIA. 

SYMPTOMS. — POST-MORTEM APPEARANCES. — CONIA. — CHEMICAL RE- 
ACTIONS. — TOXICOLOGICAL EXAMINATION. — OTHER POISONOUS HEM- 
LOCKS. 

The Conium maculatum, or Spotted Hemlock of Great 
Britain and America, is believed to be the same plant as 
the Ciciita of the ancient Greeks, the one that furnished the 
celebrated State poison by which Socrates perished. It be- 
longs to the natural order UmbellifercE, which also includes 
many other poisonous plants. All parts of this plant are 
poisonous ; the leaves and root are employed in medicine, 
in the form of fresh juice and extract. 



POISONING BY CONIA. 387 

Poisoning by hemlock is generally the result of accident, 
the fresh leaves being used in soup in mistake for parsley, 
which it somewhat resembles. Its action on man appears 
to be very variable — at least the different accounts are very 
diverse. 

Symptoms. — Headache, imperfect vision, dilated pupils, 
difficulty of swallowing, drowsiness, a tingling sensation 
along the muscles, gradually complete paralysis of the ex- 
tremltle's; this extends finally to the muscles of respiration, 
and the patient dies, at last, from apnoea. If death be de- 
layed for some time, there may be convulsions, coma, violent 
delirium, accompanied with salivation, and involuntary dis- 
charges from the bladder and bowels. Death usually takes 
place in one to three hours. One drop of conia is considered 
to be a poisonous dose. The treatment consists in a prompt 
evacuation of the stomach by emetics, or, the use of the 
stomach pump, followed by castor oil and stimulants. 

Post-mortem appearances. — These are not at all character- 
istic; redness of the mucous membrane of the stomach and 
congestion of the lungs being usually observed. Fragments 
of the leaves and the seeds (if these have been swallowed) 
may often be recognized in the stomach and bowels, with 
the aid of the microscope. If the leaves be rubbed In a 
mortar with liquor potassae, they emit a peculiar mousy odor. 

Conia. — This alkaloid exists most abundantly in the seeds. 
It is one of the most powerful and fatal poisons known. 
Christlson states that a single drop, applied to the eye of a 
rabbit, killed it in nine minutes ; and three drops, applied in 
the same manner, killed a strong cat in a minute and a half. 
In Wormley's experiments, a single drop placed upon the 
tongue of a large cat, caused the animal at first to stand 
still ; in two minutes and a half It fell upon its side, voided 
urine, had violent convulsions of the limbs, with trembling 



388 TOXICOLOGY. 

of the body, when it died in three and a half minutes from 
the time of administration. 

Treatment. — Prompt emesis, to get rid of the poison, and 
active stimulation. Strychnia has been suggested as a phy- 
siological antidote, but it is too dangerous a substance to 
deserve to be employed for this purpose. 

Chemical properties. — When pure it is a colorless, vola- 
tile, oily liquid ; the odor is peculiar, repulsive and suffoca- 
tive, resembling that of a stale tobacco pipe. Diluted with 
water, it emits an odor resembling mice. It gives a greasy 
stain to paper, burns with a bright, smoky flame ; taste dis- 
agreeable and permanent. Exposed to the air, it becomes 
yellowish and resinoid. It is partially soluble in water, 
freely so in alcohol, ether and chloroform ; the two latter 
will separate it from its aqueous solutions. 

Tests. — A drop is placed in a watch glass, and covered 
over with a precisely similar glass, holding a drop of pure 
hydrochloric acid on its under surface ; both glasses imme- 
diately become filled with dense white fumes, and the drop 
of conia is converted into a mass of beautiful, delicate crys- 
talline needles, which do not deliquesce in the air. Sul- 
phuric acid imparts to it a pale red color. Nitric acid 
causes with it dense white fumes. Strong hydrochloric 
acid imparts to it a faint tint, which gradually becomes much 
deeper, and on evaporation, needle-shaped crystals appear. 
Like the fixed alkaloids, it yields precipitates with tannic 
acid, corrosive sublimate, terchloride of gold, bichloride of 
platinum, iodide of potassium, etc. Its liquid, oily condi- 
tion, together with its peculiar odor, will distinguish it from 
all other bodies except nicotina ; and the points of differ- 
ence between the two are mentioned under the head of 
Nicotina (p. 383). 

Toxicological examination. — Search first for any remains 



POISONING BY CONIA. 389 

of leaves, or of seeds, in the stomach and intestines, and 
avoid mistaking the leaves of parsley for those of hemlock. 
Rub the leaves in a mortar, with potassa, to develop the 
peculiar mousy smell. Then distill, and examine the dis- 
tillate before employing the more elaborate process of Stas. 
Water and acetic acid may be employed as the proper sol- 
vents ; evaporate the filtered solution to a syrupy consist- 
ence, mix with strong alcohol and a few drops of acetic 
acid, filter again and evaporate to near dryness ; add a little 
distilled water, supersaturate with solution of potassa, and 
agitate with ether, repeating the process several times. Re- 
move the ether, and allow it to evaporate spontaneously. 
Dilute the alkaloid, and subject it to the appropriate tests. 
The toxicologist should guard against too strong a re- 
liance upon the supposed odor of conia. Dr. Harley justly 
observes that potassa may often develop an odor from or- 
ganic substances which might possibly be mistaken for that 
of conia, when the latter was not present. Nothing short 
of the isolation of this principle, in a search for the poison, 
should satisfy us. 

The other hemlocks, viz., CiciUa virosa, or water hemlock, 
(Enanthe crocata, or hemlock water-dropwort, and yEtJiusa 
cyjiapiuin, or Fool's parsley, or lesser hemlock, are all very 
poisonous ; this is especially true of the QLnanthe, which is 
one of the most poisonous of the umbelliferae. 



390 TOXICOLOGY. 

SECTION III. 

POISONING BY ACONITE AND CALABAR BEAN. 

PROPERTIES OF THE PLANT. — EFFECTS. — POST-MORTEM APPEAR- 
ANCES. — ACONITINE. — FATAL DOSE. — TREATMENT. — CHEMICAL 
ANALYSIS. — TOXICOLOGICAL EXAMINATION. — CALABAR BEAN. — 
ESERINE. 

Aconite. — The Aconititm napcllus (Monkshood, or 
Wolfsbane) is indigenous in Europe, but is cultivated in this 
country. It grows from two to four or five feet high, and 
has a Spike of rich blue flowers. All parts of it are poison- 
ous, the root most so, depending on the presence of the 
alkaloid aconitia or aconitine. The root is tapering, carrot- 
like, two or three inches long, having a number of curly 
fibres passing off from it. This root has frequently been 
mistaken for the root of the horse-radish, from which, how- 
ever, it differs essentially in appearance; the latter being long 
and cylindrical and truncated, not tapering, of a light 
brown color externally, white internally, and of a sweetish, 
hot and pungent taste, totally distinct from that of aconite, 
which imparts to the lips, tongue and fauces a peculiar 
tingling, numbing sensation, which is very persistent. 

There is considerable diversity in the activity of different 
specimens of aconite, depending, doubtless, on the time and 
modes of collecting and drying of the plant, and probably 
also on the place of growth. This may account for the dis- 
cordant results obtained by different investigators. 

Aconite root has been administered criminally in at least 
one recorded case, where the powdered root was mixed 
with pepper, and sprinkled over the greens used for dinner 
by the deceased (Dub. Jour., July, 1841). 

Symptoms. — On animals, according to Dr. Fleming, there 
are weakness of the limbs and staggering, respiration slow 
and labored, paralysis, loss of sensation, increased difficulty 



POISONING BY ACONITE FATAL DOSE. 391 

of breathing, and after a few spasmodic twitches, death by 
asphyxia. In a few instances there were decided convul- 
sions, and even opisthotonos. The pupils were generally 
contracted. The heart continued beating after death. There 
was great congestion of the venous system, with distention 
of the right side of the heart. 

On man. — There is first a dryness of the throat, accom- 
panied with tingling and numbness of the lips, throat and 
tongue, followed by nausea and vomiting, with pain and 
tenderness of the epigastrium. The numbness and tingling 
now become more general, with diminution or loss of sensi- 
bility of the surface, vertigo, dimness of vision, tinnitus 
aurium, with occasional deafness, frothing at the mouth, 
sense of constriction of the throat, great muscular prostra- 
tion, inability to walk, a slow, feeble pulse, difficulty of 
breathing, a cold, clammy skin, dilated pupils, features pale, 
perhaps a few convulsions, followed by death. The mind 
usually remains clear to the last. Delirium is rare. Death 
is apt to be sudden, either from shock, asphyxia, or syncope. 

Post-mortem appearances. — There is nothing character- 
istic. There is usually general venous congestion of all the 
organs, especially the brain, lungs and liver. There maybe 
redness of the lining membrane of the stomach. The blood 
is generally fluid, and dark in color. The heart may con- 
tinue beating for a little while after death, indicating that 
this was caused by asphyxia. In other cases, the death 
may be ascribed to syncope. 

The fatal dose is undetermined, in consequence of the 
diversity in the strength of the different preparations of 
the drug. The medicinal preparations are the tinctures of 
the leaves and root, and the alcoholic extract. The latter is 
apt to be inert. The tincture of the root is the strongest, 
and most reliable. Twenty-five drops of this preparation 



392 . TOXICOLOGY. 

have proved fatal. An excise officer in England died in a 
few hours after merely tasting Fleming's strong tincture. 
Pereira speaks of a case where two doses of six drops 
each, taken at an interval of two hours, produced most 
alarming symptoms in a young man; and Wormley alludes 
to an instance in which five drops of Thayer's fluid extract 
of the root produced most serious effects, which continued 
for two hours. Half a drachm to a drachm may be con- 
sidered a fatal dose. 

The symptoms may come on almost immediately, or be 
delayed for an hour or two. Death generally occurs within 
three or four hours ; but it may be deferred, as in other 
poisons, for twenty-four hours. 

AcoNiTiA {Aconitine). — The active alkaloid principle, 
abounding most in the root, of which it constitutes about 
one-tenth, to one-fifth of one per cent. In its pure state, it is 
probably the most powerful poison known. Pereira states 
that one-fiftieth of a grain nearly proved fatal to an elderly 
lady. Much of the aconitia, as sold in the shops, is totally 
inert and worthless. The only reliable article is that of 
Morson, of London, and probably some of the German 
manufacture. One-tenth of a grain may be considered a 
fatal dose. This poison has lately been brought promi- 
nently into notice in the case of Dr. Lamson, who used it in 
destroying his brother-in-law, in England, about a year ago. 

Treatment. — There is no chemical antidote. The stomach 
should be immediately emptied by the stomach-pump, or an 
active emetic. Animal charcoal is recommended by Head- 
land, also tannin, or astringent infusions. Slight galvanic 
shocks are recommended to be passed through the heart, in 
order to arouse its action, also the employment of artificial 
respiration. Possibly, the inhalation of oxygen might be of 
some advantage. 



POISONING BY ACONITIA TESTS. 393 

As strychnia and aconitia appear to be mutually antago- 
nistic, it might be well to employ the former, cautiously, in 
the treatment of poisoning by the latter. A case of a child 
is quoted, from Am. Jour. Med. Sci., January, 1862, in which 
the recovery was apparently due to two doses of tincture 
of nux vomica, administered twenty minutes apart. 

It would also appear that digitalis possesses an antidotal 
power over aconitia. Dr. J. M. Fothergill discovered that 
digitalis administered to frogs that were under the influence 
of aconite relieved the heart from the depression produced 
by the latter poison, recalling its normal movements. A 
case is reported, in the Brit. Med. Journal, December, 1872, 
where recovery took place in a man who, when intoxicated, 
had swallowed an ounce of Fleming's tincture. The patient 
was apparently dying, when twenty minims of tincture of 
digitalis were injected subcutaneously, and after twenty 
minutes the patient had recovered sufficiently to swallow, 
when a fluid drachm of the tincture was given, along with 
brandy and ammonia, and was twice repeated within an 
hour. The above statement certainly warrants the employ- 
ment of this remedy in a case of aconite-poisoning. 

Chemical analysis. — Aconitia, when pure, is in colorless, 
transparent crystals. Taste, at first, acrid, soon followed by 
tingling, and numbness of the lips and tongue. Its solution, 
applied to the skin, occasions a feeling of heat and numb- 
ness. So active is this poison that, according to Stevenson, 
one two-thousandth of a grain of Morson's aconitine will 
destroy a mouse. This same quantity causes tingling and 
numbness of the lips and tongue, when applied to the tip 
of the latter organ; and one-hundredth of a grain, dissolved 
in spirit and rubbed into the skin, causes a loss of feeling, 
lasting for some time. 

It has strong basic properties, forming salts with acids, 
18 



394 TOXICOLOGY. 

which are mostly soluble. It is very slightly soluble in 
water, quite soluble in alcohol and chloroform, but in- 
soluble in ether. None of the mineral acids change it in 
the cold, but warm sulphuric acid imparts to it a brown tint 
There is no characteristic chemical test for it. Its presence, 
in a medico-legal case, can only be satisfactorily established 
by the physiological test — the peculiar tingling, benumbing 
sensation imparted to the mouth and tongue when a minute 
fragment of the ultimate extract is tasted, or by a similar 
application to the skin, attended with similar results; to- 
gether with its introduction into some small animal, hypo- 
derm ically. 

If the poisoning has occurred from swallowing the leaves 
or root of the plant, a careful microscopic inspection of the 
stomach and bowels, and of the matters vomited and purged, 
should be instituted, in order to identify their botanical 
characters. 

Toxicological examination. — A modification of Stas' pro- 
cess should be employed, similar to that described for nico- 
tine (p. 384). Chloroform is preferable as the ultimate sol- 
vent. The residue thus obtained should be dissolved in a 
few drops of pure water, slightly acidified with acetic acid, 
and submitted to the physiological tests above described. 
If these afford no satisfactory results, no mere chemical 
tests can be relied on; but if they give evidence of the 
presence of the poison, then the solution should be sub- 
jected to all the known reactions, such as carbazotic acid, 
bichloride of platinum, chloride of gold, and the bromine test. 

Calabar Bean. — The Ordeal Bean of Calabar (Physos- 
tigma venosum) is a large leguminous seed, from an inch 
to an inch and a half long, of a brownish-black color. It is 
used by the natives of the West Coast of Africa as the 



POISONING BY CALABAR BEAN ANTIDOTE. 395 

ordeal test for witchcraft — the suspected person being com- 
pelled to drink a decoction of the poisonous beans. It owes 
its activity to the alkaloid physostigniia, also named eserine, 
which resides in the cotyledons. These, when touched with 
nitric acid, assume an orange tint, and with perchloride of 
iron, a brown one. The alkaloid is a colorless, crystalline 
solid, bitter to the taste, very slightly soluble in water ; 
soluble in alcohol, ether, chloroform and benzol. 

Bromine in bromide of potassium produces with it a red 
color. It gives this color with less than toW of a grain 
(Dragendorff). According to Dr. J. B. Edwards {Med. 
Times and Gaz., 1864), it reacts with sulphuric acid and bi- 
chromate of potassium very much like strychnia — producing 
the play of colors; this, however, needs further confirma- 
tion. 

The action of this poison upon the lower animals is that of 
a spinal depressant, causing, at first, tremors, and then 
paralysis, with muscular flaccidity; contraction of the 
pupils ; respiration slow, irregular and stertorous ; some- 
times there are convulsions. The heart is found to beat 
for some time after death. Consciousness is preserved 
throughout. 

The effects on man are similar to the above. They are 
the opposite to those produced by strychnia, which is a true 
spinal excitant. For this reason it has been employed as a 
remedy for tetanus, and also as an antidote for strychnia. 

Its most characteristic physiological action is the property 
of contracting the pupil, which at once distinguishes it from 
belladonna, as also from conia and curarin, which it 
resembles in some particulars. 

The true physiological antidote is atropia, used hypoder- 
mically, and repeated until expansion of the pupil is mani- 
fested. From the experiments of Dr. Fraser and others, 



396 TOXICOLOGY. 

there can be no doubt of the mutual antagonism of atropia 
and eserine. 

The most satisfactory test is the physiological one— its 
power to contract the pupil. A drop or two of the suspected 
fluid is put into the eye of a rabbit, or other small animal, 
and in the course of fifteen or twenty minutes the charac- 
teristic impression will be observed. 

Dragendorff has succeeded in separating it from the 
tissues by a modification of Stas' process, employing 
benzol, instead of ether, as the ultimate solvent. 

Six of the beans, when eaten, proved fatal to a boy, aged 
six years [Lancet, Aug. 27, 1864). 



POISONING BY HYDROCYANIC ACID. 397 



CHAPTER XXX. • 

(3) ASTHENICS. 

This subdivision of Cerebro-spinants comprises those 
Neurotics which destroy Hfe by asthenia, or failure of the 
heart's action. It is not intended to assert that they may 
not prove fatal in some cases, in another manner, as e. g., 
through shock, or asphyxia. But as the most strongly- 
marked symptoms are those of heart failure, this name 
answers sufficiently well for grouping together those neu- 
rotic poisons that especially display this property. The two 
most important members of this group are Hydrocyanic 
Acid and Digitalis. Cocculus Indicus is considered under 
the same head, for the sake of convenience. 

SECTION I. 
POISONING BY HYDROCYANIC ACID. 

NATURAL OCCURRENCE IN VEGETABLES. — PURE AND OFFICINAL 
ACIDS. — SYMPTOMS.— FATAL PERIOD AND DOSE. — TREATMENT. — 
POST-MORTEM APPEARANCES. — TESTS. — TOXICOLOGICAL EXAMINA- 
TION. — CYANIDE OF POTASSIUM. — OIL OF BITTER ALMONDS. — 
CHERRY-LAUREL WATER. — NITRO-BENZOLE. 

Hydrocyanic, or Prussic Acid, is one of the most 
energetic and rapidly fatal poisons known. It occurs as a 
natural product in the bitter almond, the kernels of the 
peach, apricot, plum and cherry, the pips of apples, and the 
flowers and leaves of the peach and cherry-laurel. From 
the latter, a very poisonous water (cherry -laurel zuater) is 
distilled. It also exists in the root of the mountain ash. 
Properly speaking, hydrocyanic acid does not pre-exist in 



398 TOXICOLOGY. 

these vegetable substances, but is the product of the reaction 
of water upon two principles which they contain, viz., amyg- 
dalin and emulsin, at a certain temperature. 

Prussic acid, in its pure, anhydrous state, is a compound 
of cyanogen and hydrogen, HCy. It is a colorless, limpid 
liquid, extremely volatile, and having the odor of bitter 
almonds. It is one of the most active and rapidly fatal 
poisons known. A single drop placed upon the tongue of 
a large dog caused death in a few seconds. The anhydrous 
acid is rarely met with except in the laboratory of the 
chemist. It possesses no medico-legal interest. It is the 
dilute or medicinal acid that is so frequently the cause of 
death. This latter is merely a solution of the anhydrous 
acid in water. 

It occurs in the shops under two different forms : (i) The 
officinal acid, of the average strength of two per cent. ; and 
(2) Scheele's acid, of the average strength of five per cent. 
But the strength of both varieties varies considerably, and 
it is not uncommon to find some specimens totally inert. 
This may probably arise from the liability of the acid to 
undergo decomposition when exposed to the light. The 
dilute acid is colorless, and has the odor of bitter almonds, 
and a hot, pungent taste. 

Symptojns. — These vary with the size of the dose. A 
large dose — half an ounce to an ounce of the diluted acid — 
may produce symptoms in the act of swallowing, or in a few 
seconds after. They are seldom delayed beyond one or two 
minutes. Tardieu describes them as '' coming with lightning- 
like rapidity." There is an immediate loss of muscular 
power, with giddiness ; the person staggers and falls to the 
ground ; the respiration becomes hurried and gasping ; the 
pulse imperceptible ; the eyes glassy and protruding ; the 
pupils dilated and insensible to light ; the extremities cold ; 



POISONING BY PRUSSIC ACID — FATAL DOSE. 399 

and sometimes convulsions occur. Toward the last, the 
breathing is performed convulsively, in sobs. Sometimes 
the bladder and rectum are evacuated involuntarily. As 
regards the peculiar cry or shriek, such as is often heard in 
animals poisoned by prussic acid, the experience of all 
observers is against its existence in the human subject. The 
face is livid or pallid, the jaws spasmodically closed ; there 
is frothing at the mouth, occasionally bloody ; often the 
peculiar odor of the poison can be detected in the breath ; 
death occurs sometimes in a violent convulsion; at others it 
is preceded by coma, with stertorous breathing. This latter 
symptom (stertorous breathing) is of considerable medico- 
legal importance, since it might easily lead to a mistaken 
diagnosis for apoplexy. 

Fatal period. — Death generally occurs within ten or fifteen 
minutes after swallowing the poison. Rarely is it protracted 
for half an hour. One case is recorded where an hour 
supervened. Insensibility is not, however, always imme- 
diate ; instances are recorded of persons, after swallowing 
very large and fatal doses of this poison, performing many 
voluntary acts, such as walking into another room, opening 
drawers, going down stairs, etc. 

The symptoms attendant on a large, but not fatal, dose, 
are confusion of head, giddiness, a sense of weight upon the 
brain, great muscular debility, nausea, vomiting and possibly 
convulsions, oppressed breathing. Several days may elapse 
before complete recovery takes place. 

The external application of this acid to the skin, 
especially if abraded, may occasion serious, and even fatal 
consequences. Christison reports a case where the liquid, 
applied to a wound in the hand, caused death in one 
hour. 

Fatal quantity. — The minimum fatal dose for an adult 



400 TOXICOLOGY. 

may be taken to be about fifty minims of the officinal acid, 
which is equivalent to nine-tenths of a grain of anhydrous 
acid. The largest dose from which there was a recovery 
was reported in the Lancet (January 14, 1854), in which one 
drachm of Scheele's acid, equivalent to 2.4 grains of anhy- 
drous acid, was swallowed by mistake. Other instances are 
reported of recovery after taking doses equivalent to two 
grains, and under, of the anhydrous acid, in all of which 
prompt and vigorous measures were adopted. 

The inhalation of the vapor is exceedingly dangerous, 
and has even proved fatal. 

Treatment. — So rapid are the poisonous effects of hydro- 
cyanic acid that there is scarcely any opportunity for the 
employment of remedies. The cold affusion, by dashing 
cold water over the face and chest, should be at once 
employed. This should be followed by the cautious inha- 
lation of diluted ammonia and chlorine vapors, along with 
stimulants, applied both internally and externally. As a 
cheinical antidote, a mixture of ferrous and ferric sulphates, 
followed by a solution of carbonate of potassium, has been 
proposed; this would produce, with hydrocyanic acid in the 
stomach, Prussiait blue — an inert compound. The experi- 
ment has proved successful in animals. 

Post-mortem appearances. — The face is pale, or livid ; the 
eyes often glistening and staring, with the pupils dilated ; 
the lips blue ; jaws firmly set, with, at times, a bloody froth 
issuing from the mouth. The blood is of a dark blue color, 
and fluid. The cerebral vessels are congested. Tardieu 
alludes to effusions of blood and serum at the base of the 
brain, as an occasional occurrence, which might suggest the 
presence of apoplexy, which, however, is negatived by the 
absence of hemiplegia, and by the rapidity of the death. 
There is congestion of the lungs and liver; and the mucous 



HYDROCYANIC ACID TESTS. 401 

membrane of the stomach, especially about the cardiac 
extremity, is apt to be much reddened. 

The exhalation of the peculiar odor is one of the most 
important post-mortem characters. This odor is sometimes 
perceived even before the body is opened, in recent cases, 
but it is particularly noticeable in opening the abdomen and 
thorax, and even the brain, but especially the stomach. But 
as the poison is very volatile, it may easily happen that the 
odor will have disappeared in a few hours or days, if the 
body has been much exposed. There is a singular variation 
in this respect in different cases. Moreover, the odor may 
be disguised by other more powerful smells, such as tobacco, 
mint, etc. The mere absence of odor is, therefore, no proof 
of the non-existence of the poison. 

Chemical analysis. — There are four recognized tests for 
hydrocyanic acid, which may be briefly designated as the 
silver, iron, sidphiir and copper tests. The first three are 
characteristic ; and they may be applied to the acid either 
in its form of liquid, or vapor. 

I. The Silver test. — A solution of hydrocyanic acid, or of 
a cyanide, gives with a solution of nitrate of silver a white 
crystalline precipitate, distinguishable from the white chloride, 
as follows: (i) By its crystalline characters (prisms or 
needles) ; the chloride is amorphous. (2) Its sparing solu- 
bility in ammonia; the chloride is very soluble. (3) The 
permanence of its color when exposed to the light ; the 
chloride becomes dark-colored. (4) Its solubility in boiling 
nitric acid ; the chloride is insoluble. (5) When perfectly 
dried, and heated in a small reduction-tube, the cyanide of 
silver is decomposed, evolving cyanogen gas, which burns 
with a characteristic roseate flame. (6) By adding to the 
cyanide of silver hydrochloric acid and persulphate of iron. 
Prussian blue will be formed. 
18* 



402 TOXICOLOGY. 

Another mode of identifying the cyanide of silver, re- 
commended by Orfila and Tardieu, is, after thoroughly 
washing and drying it, to introduce it into a small glass tube, 
closed at one end, from five to seven inches long, and con- 
taining in its closed extremity a rather less quantity of pure 
iodine. On heating this end of the tube very gently, beau- 
tiful snow-white crystals of iodide of cyanogen are deposited 
upon the cool portion of the tube. These crystals may be 
preserved indefinitely in sealed tubes ; and they may be used 
for developing Prussian blue, by dissolving them in a solution 
of potassa, and adding a mixture of a ferrous and ferric 
salt. 

The silver test is particularly delicate when applied to the 
acid in a state of vapor. For this purpose the material con- 
taining the suspected poison is put into a beaker, or wide- 
mouthed flask, and a watch glass containing on its concave 
surface a drop or two of nitrate of silver solution is inverted 
over the mouth of the flask, which should be gently heated 
by immersion in warm water. The vapor of the acid im- 
mediately rises, and coming in contact with the silver salt, 
forms a white, opaque spot of cyanide of silver, which can 
easily be recognized by a lens, and by the other tests men- 
tioned above. If, however, the material should be in a state 
of putrefaction, this vapor-test cannot be applied, since the 
black sulphide of silver resulting from the sulphuretted 
hydrogen of decomposition, would completely obscure the 
white cyanide. 

The silver vapor-test is considered to be the most delicate 
of all the tests. It is stated that tooVo o of a grain of the acid 
may thus be distinctly recognized. Prof Guy {For. Med., 
p. 575) mentions that a single apple pip, bruised and mois- 
tened with water, and placed in a watch glass, over which 
was inverted another glass moistened with the silver solution, 



HYDROCYANIC ACID — TESTS. 403 

yielded twenty-two distinct reactions — each spot exhibiting, 
by the microscope, crystals of cyanide of silver. 

2. The Iron test. — This consists in adding to the suspected 
solution a little liquor potassse, and then a mixture of ferrous 
and ferric sulphates ; a dirty greenish-blue precipitate is 
thrown down, which, on addition of a few drops of pure hydro- 
chloric acid, becomes clear Prussian blue. If the amount of 
the poison be very minute, there is no immediate precipitate, 
although the solution has a blue (or at first, perhaps, a 
green) color; but in time, a blue precipitate will subside. 

In a medico-legal case, where great precision is necessary, 
if the quantity is very small, it is recommended to throw 
the liquid upon a white paper filter, after adding the hydro- 
chloric acid ; the blue deposit on the paper, after washing 
with very dilute acid, will show very distinctly upon the 
white ground ; the paper when dried may be preserved for 
exhibition, if needed. 

In manipulating with this test, caution should be used not 
to employ an excess of the reagents, as this materially 
interferes with the success of the experiment. 

The iron test may also be used as a vapor test. Moisten 
the watch glass with a drop of potassa solution, and 
after exposure to the suspected vapors, add a drop or two 
of the mixed iron salts, and develop the Prussian blue by a 
drop of dilute hydrochloric acid. 

3. The Sulphur test (Liebig's test). — If sulphide of ammo- 
nium be added to a solution of hydrocyanic acid, and gently 
heated to dryness, a white sulpho-cyanide of ammonium is 
formed ; when this is touched with a drop of perchloride, 
or persulphate, of iron, there is instantly produced the 
blood-red sulpho-cyanide of iron, which is characteristic of 
the presence of prussic acid, in the absence of meconic acid 
{vid. Opium, p. 337). 



404 TOXICOLOGY. 

The sulphur test is best appHed as a vapor test. Moisten 
a watch glass with a drop or two of sulphide of ammonium, 
and invert it over the vessel containing the prussic acid, 
gently warming the latter, as above directed. The vapor 
will rise, and form the sulpho-cyanide of ammonium on the 
glass. When this is allowed to dry by evaporation, it 
appears as a white spot, and when it is touched with a drop 
of the iron salt it immediately assumes the characteristic 
blood-red color. If the evaporation should not have been 
complete, so as to thoroughly dry it, the application of the 
iron salt may produce a black stain (sulphide of iron), which 
will obscure the result. 

The sulphur test, moreover, may be applied to confirm 
the silver test. For this purpose, the spot of cyanide of 
silver should be moistened with a drop of sulphide of am- 
monium, and, when thoroughly dried, touched with a drop 
of the persalt of iron. The characteristic blood-red color 
may be distinguished, in spite of the black sulphide with 
which it is associated. 

4. The Copper test, — The liquid is first made slightly 
alkaline by liquor potassse, and a dilute solution of sulphate 
of copper is added ; a greenish-white precipitate is thrown 
down, which becomes nearly white on the addition of a 
little hydrochloric acid. 

This test may be used, also, as a vapor test. The watch 
glass is moistened with a drop of the copper solution, made 
slightly alkaline, and, after exposure, a drop of dilute hydro- 
chloric acid is added. 

As regards the relative delicacy of the above tests, experi- 
ments show that for the liquid hydrocyanic acid, the iron 
and sulphur tests exceed the silver test; but, when in the 
form of vapor, the latter far surpasses all the others. 

Toxicological examination. — The stomach, together with 



PRUSSIC ACID TOXICOLOGICAL EXAMINATION. 405 

its contents, and other viscera (having first been carefully 
examined for the peculiar odor) should be distilled in a glass 
retort, at a moderate temperature, care being first taken to 
ascertain if the material is acid or alkaline. Unless distinctly 
alkaline, no acid must be added, otherwise it will be impos- 
sible to determine whether the prussic acid found in the 
distillate was originally present in the free state, or whether 
it might not have resulted from the action of the acid used 
upon a cyanide, a ferrocyanide, or a sulpho-cyanide, that 
might have been present in the material. Therefore, in a 
medico-legal case of suspected poisoning by prussic acid, 
we deem it very unadvisable to employ any acid in the dis- 
tilling process, since, by so doing, the examiner puts it out 
of his power to determine whether the poison was really 
present in the free state, or whether he may not have actually 
manufactured it out of the sulpho-cyanide of potassium, 
which is known to exist in human saliva, and which would 
be very likely to be present in the stomach of the deceased. 
Of course, if cyanide of potassium has been the poison 
employed, the contents of the stomach would give an alka- 
line reaction, in which case the addition of sulphuric, or 
some other acid, would be perfectly proper. 

In the celebrated case of Dr. Paul Schoeppe, in Carlisle, 
Pa., in 1868 and 1872, this was made a capital point by the 
defence. The allegation at first had been that the deceased 
(a lady of fifty-four years) had been poisoned by prussic 
acid. It was afterward contended that the death was due 
to a mixture of prussic acid and morphia. The analyst 
employed the distillation process, along with sulphuric acid, 
and testified to his having only obtained faint U^aces of 
prussic acid by his process. It was very justly contended 
by the defence that these " traces " of the poison could 
readily be accounted for by the faulty process employed in 



406 * TOXICOLOGY. 

the analysis, being, in fact, the result of the action of the 
acid upon the sulpho-cyanide of potassium which is often 
found in the saliva. Moreover, there was an entire absence 
of the characteristic symptoms of the alleged poison before 
death. At the second trial, the evidence of the prosecution 
completely broke down, and the prisoner was acquitted. 

The source of the poison found in the distillate, where an 
acid is employed, may be determined by treating a portion 
of the original material with a few drops of hydrochloric 
acid, stirring the mixture for a short time, and adding the 
perchloride of iron. If the liquid contains either a ferro- 
cyanide, or a sulpho-cyanide, the former will be indicated 
by the formation of Prussian blue, and the latter by the red 
sulpho-cyanide of iron ; whereas, a simple cyanide, as cya- 
nide of potassium, will not give any reaction under the 
circumstances. 

As regards the question whether prussic acid can be 
generated spontaneously, by the distillation of putrescent 
animal matters, although Orfila appears to have inclined to 
this belief, it is not held by later authorities. Still, we are 
of the opinion that, in an important medico-legal case, in- 
volving the life of the accused, something more should be 
insisted on as proof of poisoning than the finding of ''mere 
traces " of prussic acid, since these might possibly be the 
result of some spontaneous animal decomposition, brought 
about under conditions not yet perfectly understood. Espe- 
cially should this be insisted on, where the symptoms pre- 
ceding death did not agree with those characteristic of the 
alleged poison {ind., Ptomaines, post). 

Period after death when the poison may be found. — On 
account of its volatility and ready decomposition, all traces 
of prussic acid may disappear very shortly after death. The 
most skillful analysts have failed to discover it in twenty-six 



POISONING BY CYANIDE OF POTASSIUM. 407 

hours after death, in some cases ; whilst in others it has 
been detected as late as twenty-three days after. 

The mere fact of putrefaction is no obstacle to its detec- 
tion, although in such a case it will not be discoverable, 
either by distillation, or by the vapor tests. It would have 
all been converted into sulpho-cyanide of ammonium by 
the sulphide of ammonium resulting from the putrefaction. 
In such a case, the material should be rendered slightly 
alkaline, and then acted on by alcohol, which dissolves the 
sulpho-cyanide ; filter, and evaporate to dryness ; dissolve 
the residue in water, and test by a persalt of iron. 

Quantitative determination. — Free hydrocyanic acid is 
precipitated by nitrate of silver ; the resulting cyanide is 
washed, dried, and weighed. Every lOO parts represent 
20.15 parts of anhydrous acid. 

Cyanide of Potassium. — This salt is very much employed 
in photography and electrotyping, and is a frequent source 
of poisoning to artisans engaged in the above employments. 
It is a powerful poison, causing death in doses under five 
grains. 

It is a white, deliquescent salt, very soluble in water, less 
so in alcohol, the solution giving off the prussic odor ; it 
has an alkaline reaction. 

The symptoms, post-m,ortem lesions and treatment are 
similar to those described under Hydrocyanic Acid. 

Chemical analysis. — i. It is decomposed by all acids, set- 
ting prussic acid free, which is readily recognized. 2„ It 
gives, with nitrate of silver, the white cyanide of silver. 
3. The potash is precipitated by tartaric acid, and bichloride 
of platinum. 4. The iron and copper tests may be used, as 
for prussic acid, but without the liquor potassae. 

In organic mixtures, the prussic acid may be obtained by 



408 TOXICOLOGY. 

neutralizing with sulphuric acid, and distilling at a low 
temperature. 

Oil of Bitter Almonds. — This does not pre-exist in 
the bitter almond, but results from the reaction of water 
upon its amygdalin and emulsin. It is obtained by distilla- 
tion of bitter almonds, reduced to a pulp, along with water. 
It contains a variable proportion — seven to fourteen per 
cent. — of anhydrous prussic acid, together with hydrate of 
benzole, benzoin and benzoic acid. When entirely freed 
from prussic acid, the oil is innocuous. 

Properties. — It has a light yellow color, pungent, prussic 
odor, and a bitter, aromatic, pungent taste. It is heavier 
than water, in which it is but slightly soluble ; soluble in 
alcohol and ether. It is highly poisonous. The liquid sold 
as essence of bitter almonds is a solution of this oil in alcohol ; 
it is a very dangerous substance for domestic use. 

The symptoms, post-mortem lesions and treatment are the 
same as those described under the head of Hydrocyanic Acid. 

Th.Q fatal dose is about twenty drops. 

Cherry-Laurel Water, obtained by distilling the leaves 
of the cherry-laurel (Prunus-lauro cerasus) contains a por- 
tion of an essential oil similar to the oil of bitter almonds. 
It owes its poisonous properties, like the latter, to the 
prussic acid contained. Cherry-laurel water has occasion- 
ally proved fatal. It is specially identified with the cele- 
brated Donallen case, who poisoned his brother-in law. Sir 
Theodosius Broughton, in 1782. 

The kernels of the peach, apricot and cherry have all 
proved poisonous, especially to children who have swal- 
lowed them. The symptoms are very similar to those pro- 
duced by a moderate dose of prussic acid. 



POISONING BY DIGITALIS. 409 

Nitro-Benzole, or Essence of Mirbane. — This substance 
is the product of the action of nitrous acid on benzole. It 
is a pale yellow liquid, with a strong odor of bitter almonds. 
It is used in perfumery and confectionery as a cheap substi- 
tute for the oil of bitter almonds. It is a powerful narcotic, 
producing effects resembling those of prussic acid, although 
much slower in its operation, requiring four or five hours 
before death occurs, which is usually preceded by coma, as 
in apoplexy. This poison operates more rapidly and power- 
fully when inhaled in the form of vapor. 

In a fatal case it may be generally identified by its strong 
odor. 

Chemical analysis. — It is distinguished from the oil of 
bitter almonds, which it so closely resembles in smell, by 
pouring a few drops of each upon a plate and adding a drop 
of strong sulphuric acid ; the oil of bitter almonds acquires 
a rich crimson color, with a yellow border, while the nitro- 
benzole is not affected. It gives none of the reactions of 
hydrocyanic acid with the usual tests of this acid. 

When associated with organic substances, as the stomach, 
etc., it may be separated by first adding sulphuric acid, and 
distilling. 

SECTION II. 
POISONING BY DIGITALIS.— DIGITALINE. 

SYMPTOMS. — POST-MORTEM LESIONS. — FATAL DOSE. — DIGITALINE. — 
CHExMICAL ANALYSIS. — TOXICOLOGICAL EXAMINATION. — CASE OF 
DE LA POMERAIS. 

The purple Foxglove {Digitalis purpurea) is a native of 
Europe, but cultivated in our gardens. All parts of the 
plant contain the poisonous, active principle, digitaline, 
which, however, abounds most in the leaves of the second 
year's growth. 



410 TOXICOLOGY. 

Symptoms. — Cases of digitalis poisoning are comparatively 
rare. Until recently, its action was generally regarded as a 
direct cardiac depressant, reducing both the force and fre- 
quency of the heart's action. Modern therapeutists are dis- 
posed to consider it as a direct heart stimulant, asserting 
that, while the pulsations of the heart are diminished in fre- 
quency, they are increased in power. 

The poisonous impressions in man are nausea and vomit- 
ing, purging, with severe abdominal pains, a sense of heat 
in the head, vertigo and disordered vision, dilated pupils, the 
pulse full and slow in the horizontal position, but rapid and 
feeble on sitting up. Prostration then comes on, with a ten- 
dency to syncope ; the eyes very prominent and fixed, the 
sclerotic coat acquiring, according to Tardieu, a peculiar, 
characteristic blue color. Sometimes there is salivation and 
suppression of urine ; delirium, stupor and convulsions 
are apt to occur just before death, which does not, as a rule, 
occur within twenty-four hours. Tardieu mentions a case 
who died in three-quarters of an hour after swallowing, by 
mistake, a very large dose. 

Digitalis is a cumulative poison, showing a tendency to 
break out with great violence after taking a number of 
moderate doses. The most diagnostic sign of the action of 
digitalis is the peculiar enfeebled, intermittent pulse, which 
varies so notably between the supine and the erect position 
of the patient. 

Post-mortem appearances. — Nothing very characteristic. 
Turgescence of the vessels at the base of the brain, together 
with redness of the lining membrane of the stomach. 

Fatal dose. — Not accurately settled. As much as a drachm 
of the powder, and half a fluid ounce of the tincture, have 
been taken with impunity ; but a far less quantity has pro- 
duced decided effects on the heart's action. The usual dose 



POISONING BY DIGITALINE TESTS. 411 

is one to two grains of the powder, and ten drops of the 
tincture, to be repeated. 

Digitaline. — A neutral principle, generally occurring as 
an amorphous powder, of a pale yellowish color ; sometimes 
in the crystalline state. There seems to be much diversity 
of opinion concerning the percentage of digitaline in the 
leaves ; some authorities giving it at about ten per cent., 
whilst Blaquart asserts that there are ten to twelve per cent, 
of the crystallizable variety. 

There seems to be a true antagonism between digitaline 
and aconitine. It is stated that when the heart of the frog 
has almost ceased to beat, under the influence of digitalis, 
its movements are restored by aconitine ; and a case is re- 
ported {Brit. Med. Jour., Dec, 1872) of recovery after the 
ingestion of an ounce of Fleming's tincture of aconite, ap- 
parently due to the hypodermic injection of twenty minims 
of tincture of digitalis, and the exhibition by the mouth of 
three doses of one drachm each, within an hour, together 
with brandy and ammonia (//", C. Wood's Tkerap., p. 125). 
As yet, no case of digitalis-poisoning in man has been re- 
corded, in which the antidotal virtues of aconitine have been 
tested. 

Chemical analysis. — Both the amorphous and crystalline 
varieties have a very bitter taste ; very sparingly soluble in 
water, also in pure ether ; but very soluble in ether con- 
taining alcohol. Chloroform is its best solvent. It has no 
alkaline reaction. Cold sulphuric acid imparts to it a 
brownish color, which gradually changes to a red. If 
warmed, the color passes to a brown. If to the cold brown 
solution an excess of water be added, the color changes to 
a green, depositing a green powder, and the liquid gradually 
assumes a yellowish tint (Tardieu). Strong nitric acid dis- 
solves it with effervescence, giving off red fumes and 



412 TOXICOLOGY. 

imparting an orange-red color, which gradually becomes 
fainter. Hydrochloric acid imparts to it a light-greenish 
tint. It is stated that if the brown sulphuric acid solution 
be exposed to bromine vapor, it assumes a violet hue, but 
Tardieu denies that this test is at all characteristic. 

Toxicological examination. — In a suspected case the ex- 
aminer should first carefully search for remnants of the 
powdered leaves in the matters vomited, and in the ali- 
mentary canal. If the tincture has been swallowed, the 
interior of the stomach might present a greenish color and 
emit a suggestive odor. If digitaline granules have been 
taken, a careful post-mortem inspection might possibly reveal 
the presence of some of them remaining in the stomach. 

The viscera, properly comminuted, should first be heated 
on a water-bath, with strong alcohol, for a considerable time. 
After cooling and straining, and proper concentration by 
evaporation, part of the extract may be used as a trial test 
on a small animal. The rest of it should be further purified 
by another solution in alcohol, filtration and evaporation, 
and the physiological test again repeated. 

All authorities unite in saying that, in a medico-legal 
case, it is impossible to determine the existence of the 
poison by any chemical tests, neither by the post-mortem 
lesions ; our reliance must be solely on the physiological 
test — injecting hypodermically some of the ultimate extract 
into a small animal, as the frog. It seems well established, 
by numerous experiments, that death takes place by a 
sudden cessation of the heart's action, with a decided 
rigidity of the ventricles at the moment of death. In frogs, 
this stoppage occurs always in the state of strong systole of 
the ventricle. 

By observing, then, the action of the suspected poison, 
introduced under the skin of the frog, the gradual irregu- 



POISONING BY COCCULUS INDICUS. 413 

larity and slowness of the heart-beats, together with the 
manner of its final stop, and experimenting at the same 
time, with digitahne itself, upon another animal, we may be 
able to arrive at a satisfactory conclusion. 

The most noted, if not the only, instance of homicidal 
poisoning by digitaline is that of de la Pomerais, a homoeo- 
pathic practitioner of France, who was tried and convicted 
for killing his former mistress, after having insured her life 
in various offices for his own benefit. After one of his 
visits to her she died, after suffering from violent vomiting 
and great depression of the heart's action and debility, in 
twenty-four hours. Her body was examined thirteen days 
after death, suspicion having been aroused against the 
prisoner. The examiners, Tardieu and Roussin, failing to 
discover any poison by chemical research, resorted to the 
above-mentioned physiological test, employing the extract 
obtained from the stomach and bowels and one procured 
from the scrapings of the floor on which the deceased had 
vomited, which responded also to all the known chemical 
reactions. A strong circumstantial evidence of the guilt of 
the accused was the finding in his possession an unusually 
large amount of digitaline — a substance that had only lately 
been discovered, besides a number of other deadly poisons. 
In short, he had the motive, the means and the opportunity 
for accomplishing his purpose. He was condemned and 
executed (Tardieu, Sur V Empoison., p. 694). 

Poisoning by Cocculus Indicus. — Cocculus Indicus 
(Levant nut) is the fruit of the Anamirta cocculus, a tree 
growing in the East Indies. The kernel of the berry is the 
only poisonous part. It has an intensely bitter taste, and 
contains a highly poisonous principle called Picrotoxine. It 
is chiefly employed as a fish poison, and also in Great 



414 TOXICOLOGY. 

Britain for the malicious destruction of game. It is also 
popularly believed to be used for adulterating malt liquors, 
by imparting to them a bitter flavor, with a diminished 
amouat of hops and malt. It is also used for the destruc- 
tion of vermin. 

The symptoms are somewhat singular, indicating an action 
on the cerebro-spinal centres. There is loss of voluntary 
power, but not of consciousness, the sufferer lying in a sort 
of nightmare. There may also be nausea, vomiting and 
severe abdominal pains. The late Dr. Fish, of Philadelphia, 
reported several cases of accidental poisoning by a decoction 
of this substance, of six persons in the Philadelphia Hos- 
pital. Two of these died in about half an hour. The 
remaining four were seized with violent symptoms within 
half an hour after swallowing the poison, and recovered 
after several hours. Their symptoms were faintness, con- 
fusion of mind, giddiness, dimness of vision, nausea, ex- 
cessive thirst, severe abdominal pain, and in one case, 
insensibility. The pulse was much weakened and the 
respiration slow and labored. 

The external application has been followed by violent and 
even fatal effects. 

Picrotoxine, or picrotoxia is generally regarded as an alka- 
loid. It constitutes about one per cent, of the kernel. It 
crystallizes in colorless, silken, slender, six-sided prisms. 
Sparingly soluble in water, very soluble in alcohol, ether, 
chloroform and amylic alcohol. Cold sulphuric acid does 
not affect it ; the hot acid imparts to it an orange-yellow 
color, which becomes pale on cooling. Strong nitric and 
hydrochloric acid do not affect it. It acts like grape sugar 
when boiled with sulphate of copper and potassa, and is said 
to belong to the glucosides. 

It may be separated from organic liquids, such as beer, 



POISONING BY CYTISINE, ETC. 415 

or ale, by first acidulating with hydrochloric acid, and then 
shaking up with ether, which holds the poison in solution, 
and deposits it in crystals. By this same means it may be 
separated from the stomach, in case of poisoning. 

There are several other vegetable poisons of minor im- 
portance; among them may be mentioned the bark and 
seeds of the Laburnum (Cytisiis laburnum), a very common 
tree or shrub of Great Britain. It contains an active poi- 
sonous principle, cytisine, whose effects are those of an 
irritant narcotic. Death has frequently resulted from taking 
both the bark and seeds of this plant. 

The leaves and berries of the Yew (Taxus baccata) act 
powerfully as an acrid, irritant narcotic, even in small quan- 
tities. So, likewise, do the Privet {Ligistrum vulgare) ; the 
Guelder Rose [Viburnum opulus)\ and the Holly (Ilex 
aquifolium). 



416 TOXICOLOGY. 



CHAPTER XXXI. 

THE ALKALOIDS OF PUTREFACTION— PTOMAINES. 

Within the past few years the attention of toxicologists 
has been called to the existence of a certain class of bodies, 
to which Selmi has given the name of Ptomaines, resulting 
from the decay of organic substances — chiefly animal. 
These bodies strongly resemble the vegetable alkaloids in 
their chemical and physiological actions. Some of them are 
very poisonous, some are inert, and others again seem to act 
antagonistically to certain poisonous alkaloids. 

There is, as yet, considerable uncertainty and vagueness 
about these bodies, so that we are not qualified to speak 
positively concerning them. It has long been known that 
putrescent meat will occasion severe, and sometimes fatal 
symptoms in persons who partake of it. These symptoms 
are of a narcotic-irritant character, and strongly resemble 
those produced by certain famihar poisons. Similar effects 
are also known to occasionally result from cheese, sausages 
and certain shell-fish, particularly from mussels {vid. ante, 
p. 328); and, in some instances, from canned vegetables. 
These anomalous symptoms have been attributed to various 
causes, but hitherto no very satisfactory explanation of them 
has ever been offered. If the existence of the cadaveric 
alkaloids, or ptomaines, should be positively demonstrated, 
the natural inference would then be that these were the true 
cause of the morbific symptoms above alluded to. 

It has been further stated that decomposed maize con- 
tains a poisonous alkaloidal principle, which is capable of 
producing tetanic symptoms, and which are sometimes 



PTOMAINES. 417 

attended with narcosis ; and Ranke contends that the 
proper physiological action of the impure strychnia ex- 
tracted from a putrefied body, may be masked by ptomaines. 
If this observation is correct, the fact may serve as a very 
plausible explanation of the occasional failure to discover 
strychnia and other alkaloids in a putrescent body. A con- 
venient process for obtaining these bodies, according to H. 
Maas {Am. Jour. Med. Sci., July, 1884, from Gaz. Hebdom), 
is to treat the putrefied mass with alcohol and acetic acid 
for several days; filter, and repeat the process. Reduce 
the alcoholic extract on a water-bath, and concentrate the 
aqueous extract to a syrup. This may be employed for 
experimentation on animals. By treating this acid solution 
with ether, or amylic alcohol, or chloroform (first adding 
soda), several different alkaloids have been separated, which 
exhibit different physiological effects on frogs — one acting 
like morphia, another like strychnia, and a third paralyzing 
the heart and decomposing the blood. 

Some ptomaines strongly resemble, in their properties 
and effects, the alkaloid aconitine ; others act very similarly 
to veratrum, morphia and codeia; and they might easily be 
confounded with them in a medico-legal investigation. 
Methods of discriminating between them have, however, 
been devised, in the use of potassium ferricyanide and 
silver bromide, as reagents, the former being reduced to the 
ferrocyanide in the presence of a ptomaine ; while no such 
reduction occurs if an alkaloid is present. Selmi and others 
have succeeded in extracting poisonous bases from the urine 
of patients suffering from tetanus, progressive paralysis and 
miliary fever ; one of these resembled nicotina in its general 
character, showing a special tendency to act upon the spinal 
marrow and heart ; the other base resembled conia in odor. 

Still later researches go to prove that animal fluids, such 
19 



418 TOXICOLOGY. 

as fresh blood and albumen, before undergoing putrefaction, 
give precisely similar reactions, with the reagents employed, 
to those that are afforded by these same reagents with 
ptomaines extracted from a dead animal body. 

It will be inferred from all that has been stated about the 
so-called ptomaines, that the whole matter may be regarded 
Rs being still Slid j'l/ dice ; and in the language of Dr. Steven- 
son (from whose article in Taylor's Prin. and Prac. of Med. 
Jurisp.y 1883, much of the above is taken), " the existence of 
poisonous cadaveric alkaloids in human viscera, even when 
putrid and diseased, is, to say the least, very rare." Never- 
theless, it cannot be doubted that their alleged existence will 
be constantly employed by counsel in defending a criminal 
charged with poisoning with one of the vegetable alkaloids ; 
urging strongly before the jury the possibility that the 
alleged poisonous alkaloid was in reality one of these spon- 
taneously generated ptomaines. Such a course is stated to 
have been actually taken at the late Lamson trial, which 
occurred in London, in 1883. 



FEIGNED DISEASES. 419 



CHAPTER XXXII. 

FEIGNED DISEASES. 

GREAT VARIETY OF SIMULATED DISEASES. — FICTITIOUS AND FACTI- 
TIOUS DISEASES. — GENERAL RULES FOR DIAGNOSIS. — SPECIAL 
DIAGNOSIS. 

I, Feigned Bodily Diseases. — These become the sub- 
ject of medico-legal inquiry very frequently, especially as 
found among soldiers, sailors and prisoners, who are ever 
ready to resort to all sorts of pretexts to escape hard duty, 
to avoid certain kinds of punishment, or to secure comfort- 
able quarters in a hospital. Among civilians the same 
fraud is sometimes attempted, as in an alleged incapacity for 
military service, or to undergo imprisonment for debt, or to 
discharge the duties of a juror, or witness at court. As 
Casper properly remarks, this simulation of disease is 
sometimes carried out by a purely mental effort, as by 
cunning, lying or mimicry ; at others, by the aid of material 
means of various kinds, such as crutches, bandages, trusses, 
cutting instruments, spectacles, etc. All such cases of pre- 
tended disease are termed fictitious by Dr. Ogston. There 
is another class which are actually produced by the patient 
at his convenience, or at least are exaggerations of some 
trivial complaint ; these are named factitio2is by the above 
author. 

The ingenuity of malingerers is almost incredible. Not 
only may they resort, when occasion requires, to all manner 
of disgusting performances, such as swallowing excrement 
or blood, or other offensive substances, to carry out the par- 
ticular role they wish to play, but they may also actually 



420 MEDICAL JURISPRUDENCE. 

maim, or injure certain organs for the purpose of gaining 
their object '' The greatest difficulty in detecting imposture 
arises when we examine the subjective symptoms ; and 
extreme caution is then needed, besides the adoption of the 
most deHcate tests, which should repeatedly be made use 
of, until we are satisfied as to what is the real condition of 
the patient" (Hamilton). 

Simulated diseases were much more common in former 
times than at present. We rarely now hear of such extra- 
ordinary cases of deception as we read of in the old books, 
of persons vomiting frogs and lizards, or snakes, passing inky 
urine, or discharging immense stones from the bladder, etc. 
Such instances of fraud would soon be detected, on account 
of the improved modern means of diagnosis. 

It is proper that the legal physician should understand 
the reasons or motives of the malingerer for feigning 
disease, since these may often aid him in unmasking the 
deception. These motives may be classed under the 
following heads : — 

1. Fear. — As, for example to avoid military service; or, in 
the case of the soldier, to be excused from going into battle. 
According to Beck, the observations of Mr. Lane, on the 
modern Egyptians, show that the practice of breaking out 
one or more teeth, or cutting off a finger, or putting out 
an eye, was exceedingly common among the young men 
throughout that country. The same motive influences 
culprits to escape certain species of punishment which they 
have deserved, such as flogging, or the treadmill. 

2. Gain. — This is a very prevalent and powerful motive 
to simulate disease, as, e. g.^ to obtain damages for some 
alleged injury, either public or private; it is often the source 
of groundless charges in railway accidents ; to procure 
better quarters, either in a hospital, or almshouse ; to obtain 



FEIGNED DISEASES: — MOTIVES. 421 

a divorce; to excite commiseration and aid from the benevo- 
lent; and in numerous other methods. 

3. Laziness. — As in beggars and others, to escape work, 
and live in idleness. 

4. Notoriety. — This is chiefly witnessed in hysterical 
women, who will simulate almost every variety of disease, 
and submit to painful treatment; who will frequently muti- 
late themselves^ and pretend to take poison,or destroy them- 
selves in some other manner, and with no other conceivable 
motive except to gain notoriety. 

As regards the inoeie of diagjtosis, the following general 
rules may be observed : Cunning and shrewdness must be 
met by the exercise of these same qualities on the part of 
the examiner. In nothing, are experience and tact of greater 
assistance to their possessor than in the management of this 
sort of cases. The examiner should always bear in mind 
that simulation may be possible, and that this is likely to be 
practiced in a given case, if a sufficient motive exists ; he 
should try to discover this motive, using great caution in 
the attempt. 

Do not be content with a single examination of the patient, 
but surprise him with an unexpected visit, made soon after 
the first one. Observe him closely when he is not aware 
of your notice ; by this means the deception may often be 
discovered, when he is off his guard. 

Ascertain whether the patient's account of the rise and 
progress of his disease is in accordance with known medical 
facts connected with the history of the real disorder. It is 
often useful to mention in the patient's hearing certain false 
symptoms of the alleged disease, and afterwards ask him 
after these symptoms ; when, if simulating, he will be very 
apt to enact them just as he heard them. Always suspect 
one who complains of a multitude of ailments, and which 



422 MEDICAL JURISPRUDENCE. 

have no natural connection with each other. All local 
ailments, on parts of the body covered with the clothing, 
require to be examined with the parts uncovered; all dress- 
ings and bandages must be removed. Do not be deceived 
by cicatrices, cupping scars, leech bites, or blisters. No 
importance whatever is to be attached to the statements of 
relatives or friends, since they would naturally sympathize 
with the patient. 

Anaesthetics (ether and chloroform) may sometimes be 
employed successfully in suspected cases of contracture of 
the spine or muscles. A very successful method is to 
threaten, and even use, some very repulsive medicine or 
remedy, as powerful revulsives, and especially the actual 
cautery ; but there are some cases that prove obstinate and 
unconquerable, even under this severe ordeal. 

Special Diagnosis, — Feigned Pain. — There is probably 
no symptom so commonly complained of by the malingerer, 
and none more difficult to determine by the examiner, than 
pain, because it is purely a subjective symptom. Hence, it 
will try the skill and tact of the physician to the utmost. 
A close and patient investigation will, however, usually 
detect the fraud. The simulator will either be too exactly 
correct in his description, or else entirely incorrect in his 
localization. He will exhibit great distress under the 
slightest pressure, when his attention is directed to the part ; 
but when this is directed elsewhere, no evidence of pain is 
manifested. Questions, or hints, skillfully thrown out, may 
put him off his guard, and reveal the deception. A favorite 
seat of pain is the back, and it is usual among soldiers to 
attribute it to rheumatism, contracted by exposure from 
sleeping on the damp ground. Of course, there are some 
real sufferers from this cause, but they are outnumbered by 



FEIGNED DISEASES FEVER. 423 

the simulators. The latter may often be detected by close 
watching when they think they are unobserved. Their 
agility of motion contrasts wonderfully with their lameness 
and difficulty of movement when they come into court, or 
before the medical officer for examination. 

If the pain complained of is very severe and persistent, 
and there is an absence of all other concomitant symptoms, 
there is strong room for suspicion. So, too, if the person 
complains of intolerable pain in executing certain muscular 
movements, but evinces no suffering when exercising the 
same parts, but in a way more in accordance with his 
wishes. " A young lady, desirous of escaping her piano 
practice, complains of pain in one arm and shoulder, and 
gains the sympathy of her unthinking mother, while the 
same day she may devote one or two hours to lawn tennis, 
or use her hands in other ways, and give no report of pain " 
(Hamilton). Beck refers to the case of a girl of fifteen years, 
who, in order to be taken away from school, complained of 
severe neuralgia of the face. On a subsequent occasion, when 
a recurrence of the pain was complained of for some similar 
motive, Dr. Thompson very successfully employed a strong 
mental remedy, based upon the known antipathy she had to 
a dog. He informed her that the only remedy remaining 
was to rub the affected part over the back of that animal. 
The result was a complete and immediate cure, without the 
application of the remedy. 

But, admitting the frequency of malingering in the case 
of pain, the examiner should, on the other hand, avoid the 
risk of making a too hasty diagnosis, since there may be 
cases of real occult disease accompanied with pain, and 
where the latter symptom may be wrongfully attributed to 
imposture. 

Fever, especially of the intermittent and ephemeral types. 



424 MEDICAL JURISPRUDENCE. 

may sometimes be cleverly imitated. The heat of skin and 
excitement of pulse has been produced by the use of stimu- 
lants, as spirits cantharides, etc., and by friction on the skin ; 
the coating of the tongue, by the use of chalk, pipe clay, 
liquorice, etc. Dr. Cheyne was sent for to a soldier who 
was said to be in the chill of an intermittent. He found 
him shaking violently, but, on throwing off the bed-clothes, 
he was seen, not in the cold, but in the sweating stage, pro- 
duced by his exertions. 

Pretended Heart-disease. — Extreme feebleness of the pulse 
has been produced by ligatures around the arm, by pressure 
upon the axillary artery, and in certain individuals, by tak- 
ing a deep inspiration and suspending the breathing. The 
case of Col. Townshend, reported by Dr. Cheyne, was of a 
similar character, where there was a voluntary suspension 
of the heart's action for a limited period. Palpitation may 
be excited by tke internal use of various drugs, as tobacco, 
digitalis and American hellebore ; also by introducing these 
substances into the rectum. The stethoscope should be 
used in all suspected cases. 

Feigned Consiimptio7i. — This disease has been simulated 
by coughing, and producing emaciation by abstinence and 
the use of vinegar ; by pricking the gums or fauces, and 
spitting up blood ; by mixing the sputa of ordinary catarrh 
with pus and blood, etc. A careful stethoscopic examina- 
tion will usually detect the imposture. Foreign blood may 
also be discovered by the microscope. HcEmatemesis has 
been imitated by the patient swallowing blood, and then 
throwing it up in the presence of spectators. Casper men- 
tions a case of a woman who exhibited a bloody handkerchief 
as an evidence of her having vomited blood, but which, on 
microscopic examination, proved to be the blood of a bird. 
Hcematuria has been feigned by mixing blood with the 



FEIGNED DISEASES EPILEPSY. 425 

urine, or by using substances that have the power of red- 
dening this secretion. The suspected patient should always 
be made to urinate in the presence of the examiner, and the 
urine be properly examined for blood. 

Feigned Incontinence of Urine. — This is frequently practiced 
by soldiers, in order to get into a hospital. A good plan to 
detect the imposture is to give an opiate at night, and intro- 
duce the catheter during his sleep ; or by taking him by 
surprise during the day, and introducing the instrument, 
when it will be found that the urine has not drained off 
guttatini, as it was secreted, but that the bladder possesses 
the power of retention. If the disease is real, the prepuce 
and glans penis are found to be pale, from its continuance, 
and always moist ; and the clothes exhale an ammoniacal 
odor. 

Feigned Epilepsy. — This disease is very frequently simu- 
lated, probably for the reason of the pity and affright that it is 
apt to inspire ; and also on account of the short duration 
of the paroxysm, and the length of the interval during 
which the patient may enjoy his liberty. Impostors affect 
the most violent forms of the disorder, suddenly falling 
down in convenient places, and writhing in great contor- 
tions ; they thus are apt to overdo it. Many cases may be 
unmasked by threats, or by applying a strong faradic current, 
or the actual cautery. But instances are related where the 
impostor has suffered all manner of injury rather thaa con- 
fess, and the noted Clegg, " the dummy clencher," threw 
himself, in one of his pretended paroxysms, from a corridor 
to the floor, a distance of nearly twenty feet. 

Sometimes the impostor will produce frothing at the 

mouth, by inserting a piece of soap behind the cheek. In 

suspected cases it is, therefore, well to examine the mouth. 

If closely watched, .the malingerer maybe observed to look 

19* 



426 MEDICAL JURISPRUDENCE. 

about him, or to show some interest in the result of his ac- 
tions. In real epilepsy, there is an entire loss of conscious- 
ness, and also of sensation to the severest applications. De- 
Haen relates the case of a beggar in Paris, who often fell in 
the streets. A bed of straw was prepared, through com- 
passion, on which he might be laid, to prevent injury to him- 
self When next attacked, he was laid on it, and the four 
corners set on fire. He sprang up and fled. 

The best plan is for the examiner to be fully acquainted 
with the phenomena and signs of the genuine disease, so as 
to be able to compare them with the feigned. In true epi- 
lepsy the patient falls forward, and as he falls he is very 
pale ; during the convulsion, the features are turgid and livid, 
the veins of the neck swollen ; the pupils dilated and insen- 
sible to light ; the hands clenched, with the thumbs closed 
within the hands. If the hands be forced open they remain 
relaxed, whereas in the feigned, they immediately close again. 
The muscular rigidity is simultaneous over the whole body; 
nor is there any regular period for the return of the fits. Thus, 
a simulated case was detected by the surgeon stating in his 
hearing that the real disease always came on in the morn- 
ing; he swallowed the bait, and the subsequent attacks 
always occurred before noon. In the real disease the sense 
of smell is entirely abolished. Occasionally there may be 
hemiplegia. The urine, faeces and semen may often be dis- 
charged during the paroxysm. Ecchymoses are sometimes 
found on the shoulders after a fit ; and bruises and other 
injuries may sometimes be met with, as results of the fall. 

Beck mentions another fact that should be remembered, 
namely, that the real epileptic is desirous of concealing his 
situation, through a sort of false shame, whilst the pretender 
talks about the disease, and apparently delights in publicity. 
In the feigned, the glottis is not closed, and respiration, 



FEIGNED DISEASES UNCONSCIOUSNESS. 427 

•though impeded, is not interrupted ; nor does the face 
become so swollen or livid as in the real. 

Feigned Paralysis. — This disease is frequently simulated, 
usually in a single limb, but sometimes in both the upper 
or the lower extremities. In such cases, it will be found 
that there is usually more or less rigidity ; that there is no 
atrophy, as in the real, and that the electric currents will 
produce their usual reactions. The sensation and reflex 
movements, moreover, are not lost. 

One of the most efficient means of detecting the impostor 
is to administer a severe electric shock. Suddenly and 
unexpectedly seizing the paralyzed limb will sometimes 
discover the fraud, by the patient's exerting his strength to 
prevent the raising of the limb. 

Hutchinson administered to one who pretended to have 
paralysis of his right arm a large dose of laudanum secretly, 
in his tea, and when he was sound asleep he tickled his 
right ear with a feather, when instantly the lame hand was 
raised. In some cases, the pretence may be unmasked by 
the use of anaesthetics ; and in one of paralysis of the legs, 
reported by Marshall, after every attempt to discover the 
fraud had failed, it was finally brought out by rubbing 
cowhage [Dolichos pruricus) on the soles of the feet at bed- 
time. He walked, and groaned all night, and the next 
morning reported himself fit for duty (Beck). 

Feigned Unconsciousness ^ Trance, Catalepsy and Somnam- 
bulism. — These different nervous conditions may all be 
simulated, where there is sufficient motive ; but careful 
watching and study of the cases will usually succeed in 
detecting the imposture. 

One of the most remarkable cases of feigned unconscious- 
ness is that of Phineas Adams (quoted by Beck from the 
Ed. An. Register, vol. IV, part 2, p. 159). This man was a 



428 MEDICAL JURISPRUDENCE. 

soldier, and was imprisoned for desertion. He remained- 
apparently unconscious for over two months, in spite of the 
most powerful applications in the form of revulsives, even 
to the cutting down through the scalp upon the skull. As 
his case was considered hopeless, he was discharged, and in 
a couple of days he was seen perfectly restored and assisting 
his father in thatching a rick. 

Feigned Diseases of the Eye. — Ophthalmia is artificially 
produced by the introduction of irritants into the eye. It is, 
however, detected by the rapidity of its progress, arriving at 
its height within a few hours after the application of the 
irritant. In soldiers, sometimes only one eye is affected, 
and almost uniformly the right one — the one with which he 
takes aim. A left-handed man would probably inflict the 
injury on the left eye. 

It is sometimes difficult to detect cases of blindness 
arising from amaurosis. In this disease, the pupil is usually 
dilated and fixed ; but there are cases in which it retains 
some contractile power. The patient should be carefully 
watched to see whether he avoids obstacles placed in his 
way. If the pupil contracts perfectly, there is no doubt 
about the case being feigned. The dilated, immovable 
pupil may be imitated by the use of belladonna or other 
mydriatics. 

Feigned Deafness may often be detected by making a 
noise at an unexpected moment, or by letting a piece of 
silver fall behind him; he will be very apt to turn his head 
in the direction from whence the noise proceeded. The 
suspected person should be taken unawares, the tone of 
voice should be changed, his countenance should be 
watched while you are relating something in which he is 
personally interested. The real deaf person usually con- 
verses in a low tone of voice. 



FEIGNED DISEASES PRETENDED WOUNDS. 429 

Dunlap mentions the case of a soldier who pretended 
deafness so well, that firing a pistol at his ear produced no 
effect; but on trying the experiment after he had been put 
to sleep by opium, he started up out of bed. 

Pretended Deaf-mutism is more difficult to maintain than 
pretended deafness. The best plan, in order to detect the 
imposture, is to say something that deeply interests the 
patient, and watch the physiognomy. Notice also if a body 
let fall near the person will, by its vibrations, cause him to 
look around. The application of a strong faradic current 
over the larynx will sometimes succeed in detecting the 
fraud. 

The case of Victor Travanait illustrates the ingenuity and 
perseverance of some of these cases. This young man suc- 
ceeded for four years in eluding the closest scrutiny exer- 
cised upon him throughout Europe ; he was, however, at 
last discovered by the celebrated Sicard, of Paris. 

Fictitious Tumors and Enlargements. — These are generally 
feigned by impostors for the purpose of exciting sympathy 
and material aid. Hydrocephalus in children, and local 
dropsy in both children and adults, are simulated by blow- 
ing up the cellular tissues, under the skin, and by ligatures 
on various parts of the body. Mahon relates the case of a 
young woman of Strasburg, whose abdomen commenced to 
swell, and continued to do so for thirty-nine years, by which 
means she excited the commiseration and charity of all who 
saw her, and by which she procured a comfortable support. 
At her death, in place of the supposed tumor, there was 
found merely an enormous sack or cushion, which she had 
habitually worn over her abdomen. She never would con- 
sent to a medical examination, for obvious reasons. 

Pretended or Factitious Wounds, or voluntary mutilations, 
are inflicted for various purposes, as for attracting sympathy. 



430 MEDICAL JURISPRUDENCE. 

or cloaking some criminal act that may have been com- 
mitted. Mutilation of the thumb was common among the 
conscripts of ancient Rome; and it was quite common 
among soldiers during modern wars. to inflict similar in- 
juries upon themselves, either by fire-arms, or by cutting 
instruments. 

The case of Whittaker, the colored West Point cadet, 
affords an illustration of self-inflicted wounds, along with an 
affected unconsciousness, for the purpose of carrying out a 
certain scheme. This youth had repeatedly failed in his 
studies; and upon the eve of his examination, which would 
most probably have resulted in his suspension, he made a 
desperate attempt to excite the sympathy of the community, 
as well as to gain time for study. One morning he was 
found in his sleeping room apparently unconscious, and tied 
to his bed with strips of muslin. There were several slight 
cuts, one on the ear, and another across the toe. He con- 
tinued apparently unconscious of all surroundings for some 
time, when he opened his eyes in a stupid condition. His 
story was that he had been surprised several hours before, 
by a band of masked men, who felled him to the floor, and 
who, after wounding and threatening him, left the room. 
Numerous circumstances showed that the whole thing was 
an imposture, and on trial, he was found guilty, but his 
sentence was modified (Hamilton). 

Another case was that of a bank cashier, who was found 
gagged and tied, and wounded in a superficial manner, 
while the funds of the bank were missing. It was afterward 
discovered that the wounds were self-inflicted, and that other 
preparations were made for the purpose of diverting sus- 
picion from himself 

In cases of this character, one very suspicious circum- 
stance is, that the wounds are always superficial, and not 



FEIGNED DISEASES. 431 

of a dangerous character ; they are usually mere cuts or 
scratches. Moreover, the cuts or stabs made in the gar- 
ments will often be found not to correspond with those 
made on the body. It sometimes happens that slight and 
trivial injuries received in a railway or other collision, are 
magnified purposely, in order to obtain larger damages in 
a suit at law. Again, persons who have unsuccessfully 
attempted to commit suicide are apt to attribute their 
wounds to another. In such cases, the injuries are super- 
ficial, made by the right hand, and in front, while the hands 
themselves are seldom wounded, while, in a real assault, the 
hands are very apt to be cut and maimed. 

Feigned Pregnancy and Delivery will be hereafter con- 
sidered. 

11. Feigned Mental Disorders will be discussed under 
the head of Insanity {post). 



432 MEDICAL JURISPRUDENCE. 



CHAPTER XXXIII. 

PREGNANCY. 

CASES WHERE IT BECOMES THE SUBJECT OF MEDICO-I.EGAL INVESTI- 
GATION. — SIGNS OF PREGNANCY, UNCERTAIN AND CERTAIN. — UNCON- 
SCIOUS PREGNANCY. — PREGNANCY IN THE DEAD. 

The occasions where the subject of Pregnancy claims the 
attention of the medical jurist are the following: (i) A 
woman may declare herself pregnant with an heir to an 
estate, for the purpose of defrauding the heirs-at-law; (2) for 
the purpose of extorting money from a seducer or para- 
mour; (3) to stay the infliction of capital punishment until 
after delivery ; (4) the plea of pregnancy may be set up as 
an excuse for non-attendance at a trial ; (5) an accusation 
of pregnancy may be made against a single woman, or one 
living apart from her husband, which may result in an action 
for damages for slander; (6) accusations of malpraxis may^ 
be made against a medical man for error in diagnosis of 
pregnancy, or an attempt to bring on an abortion; (7) a 
married woman, to please her husband, or from some other 
cause, may assert that she is pregnant. 

On the other hand, pregnancy may be concealed (i) in 
order to procure abortion or infanticide ; (2) in both the 
married and unmarried, in order to avoid disgrace. 

The Roman law exempted a pregnant female from capital 
punishment until after delivery. The laws of most modern 
countries follow the Roman custom in this matter. By the 
old English law, under the writ of de ventre inspiciendo^ 
" a jury of twelve matrons, or discrete women," was sum- 
moned to ascertain the fact of pregnancy in the civil case, 



SIGNS OF PREGNANCY. 433 

and the further fact of the woman's being " quick with 
child," in a criminal accusation. In Scotland, the preg- 
nancy simply must be proved, without reference to quicken- 
ing, and without the jury of matrons. At the present day, 
both in England and in our own country, the **jury of 
matrons " has been very properly superseded by a jury of 
instructed physicians. 

To enable the legal physician to decide upon the fact 
of pregnancy, he must necessarily be acquainted with its 
signs. These may be described under the heads of (i) the 
uncertain, and (2) the certain, or positive signs. 

I. Uncertain Signs.- — These comprise the following : — 
(a) Suppression of the Catamenia. — This may be regarded 
as a very probable sign of pregnancy if it occurs, after inter- 
course, in a woman who was always regular; and if at the 
end of three months she recovers her usual health, since, if 
the suppression were the result of disease, a general loss of 
health would be apt to follow. But there are many excep- 
tions, as where the menses are suppressed, temporarily, by 
disease; where menstruation continues throughout preg- 
nancy ; where it has never occurred in the woman at all, 
and yet she gave birth to several children, and continued in 
good health ; and where the catamenia appeared only dur- 
ing pregnancy, but were absent at other times. In cases of 
concealed pregnancy, the woman may stain her linen with 
blood (and even with borrowed menstrual blood), for the 
purpose of imitating "menstruation. This deception may 
generally be detected by close watching, and still more 
accurately by a macroscopic examination of thev suspected 
stains. Menstrual blood does not coagulate so readily as 
ordinary human blood, on account of the vaginal mucus. 
It also contains epithelium scales, easily recognized by the 
microscope. 



434 MEDICAL JURISPRUDENCE. 

[b) Morning Sickness. — Nausea Is very apt to be an early 
accompaniment of pregnancy, sometimes as early as the 
second or third week after conception. It usually ceases 
after quickening, but it may continue throughout the whole 
period as a most distressing symptom. There are many 
cases, however, where it does not occur; hence it is an 
uncertain sign of pregnancy, as also for the reason that 
nausea frequently accompanies many diseases. 

ic) Enlargement of the Abdomen. — In pregnancy, the en- 
largement of the abdomen begins to be obvious after the 
end of the third month, when the uterus rises out of the 
cavity of the pelvis. At about the fifth month, it is midway 
between the pelvis and umbilicus, which latter it reaches 
at the end of the sixth month. During the seventh month, 
it reaches half way between the umbilicus and the ensiform 
cartilage ; at the end of the eighth month, it is on a level 
with this cartilage. During the ninth month, it does not 
ascend higher, but the tumor widens somewhat, and falls 
slightly forward. 

This sign is subject to many fallacies : the enlargement 
may proceed from ascites, ovarian dropsy, ovarian tumor, 
retained catame?iia, flatus of the intestines, impacted fceces, 
excess of fat, distention of the bladder, and enlargement of 
spleen and kidney. Great caution is necessary in order to 
make a correct diagnosis ; mistakes have often happened, 
even to the experienced examiner. Intestinal flatus could 
be distinguished by percussion ; the presence of fluid 
(ascites and ovarian dropsy), by palpation ; ovarian en- 
largement by its history and progress. In true pregnancy, 
after the seventh month, the tumor will sensibly contract 
under the cold hand, and the foetal movements may be dis- 
tinctly felt. The outlines of the foetus also can often be felt. 
A dark line extending from the umbilicus to the pubis may 



SIGNS OF PREGNANCY. 435 

also generally be distinguished (Montgomery) ; but this may 
date from a previous pregnancy, and also may accompany 
ovarian enlargement. 

The enlargement of the abdomen may lead to unfounded 
suspicions reflecting upon the reputation and happiness of 
the female. Hence the importance of a correct diagnosis. 
In certain puzzling cases, where the enlargement is accom- 
panied by subjective signs on the part of the woman 
simulating the movements of the child, it may be traced to 
accumulation of flatus in the intestines, accompanied by con- 
traction of the abdominal muscles, constituting a phantom 
tmnor ; this condition is best cleared up by placing the 
woman under ether, when the enlargement will be found to 
subside. 

id) Quickening. — By this term is understood the first per- 
ception by the mother of the movements of the foetus. Its 
usual time of occurrence is from about the sixteenth to the 
twenty-fourth week — sometimes earlier, sometimes later. It 
may often be absent altogether, even when a healthy child 
is born. Its cause is ascribed either to the rising of the 
uterus out of the cavity of the pelvis, or to the increased 
activity of the foetus, or to the latter now coming in contact 
with the uterine walls. However produced, it is a very 
deceptive sign of pregnancy, as it is purely a subjective 
symptom, and many nervous women, especially when 
anxious to have children, will mistake movements of the 
intestines and the contraction of the abdominal muscles for 
the motions of a child. 

{i) Development of the Breasts. — As a general rule, during 
the progress of pregnancy, the breasts become larger, fuller, 
more knotty, and tender to the touch ; enlarged veins course 
along the surface ; the nipples and the surrounding follicles 
become more prominent ; the areola widens and assumes a 



436 MEDICAL JURISPRUDENCE. 

darker hue, especially observable in brunettes. In fair 
women, these changes are often not noticeable. Besides, 
enlargement of the breasts often occurs in suppression of 
the menses, in uterine fibroids, and in ovarian and uterine 
disorders. An excessive adipose secretion around the 
breasts is liable to be confounded with a true enlargement 
of the mammary gland. 

The increased development of the breasts, being due to 
the secretion of milk, is more observable towards the end 
of the pregnancy, when, frequently, this secretion is mani- 
fested. 

But the presence of milk in the mammary gland is no 
proof of pregnancy, since it has frequently been seen in the 
unimpregnated female, and even in young girls. Dr. E. 
Warren, of North Carolina, relates an instance of a woman, 
aged fifty-five years, whose catamenia had ceased, and who 
was in poor health, when she undertook to bring up the 
child of a deceased friend. To keep it quiet at night, she 
was accustomed to put it to the breast. In six months the 
secretion of milk was perfectly established, and she con- 
tinued to nurse it for twelve months, the child becoming 
healthy and strong (Wharton and Stilles Med. Jiirisp., vol. 
II, p. 12). Still more remarkable are the cases of secretion 
in the breasts of males. Dr. Dunglison {Physiol., p. 833) 
relates the case of a man aged fifty-five years, who performed 
the office of wet nurse for several years. 

(/) Kiestein in the Urine. — This is a fatty pellicle which 
forms on the urine of pregnant women after standing for a 
few days. It is believed to consist of casein, associated with 
the phosphates. It is not pecidiar to the urine of pregnancy, 
and hence must be regarded as an uncertain sign. 

(<^) '^^^^ violet color of the vagina, due to venous conges- 
tion (Jacquemin's test), commencing about the fourth week. 



SIGNS OF PREGNANCY. 437 

This is considered, by Montgomery and others, as a very 
certain sign of pregnancy, though its absence is not to be 
regarded as a negative proof. Dr. R. Barnes regards the 
flattening of the upper wall of the vagina as a reliable sign 
of pregnancy in the early months. It is attributed to the 
enlargement of the womb with slight anteversion, throwing 
the OS backwards, and rendering the superior wall of the 
vagina tense. 

II. Certain or positive signs. 

{a) Ballotteinejtt. — This test will determine the presence 
of a foetus (or some floating body) in the liquor amnii, 
as early as the fifth or sixth month of pregnancy. It is 
practiced by causing the woman to stand upright, and in- 
troducing a finger into the vagina up to the mouth of the 
womb, while the other hand is placed over the abdomen, so 
as to steady the uterine tumor. If the tip of the finger is 
now suddenly jerked upwards against the os, a sensation 
will be imparted to it as from a body floating upwards in a 
liquid and falling back again to strike the finger. It is stated 
that floating tumors of the uterus, attached to its walls by a 
pellicle, may produce the same sensation to the finger. 

(b) Change in the body and cervix of the uterus. — The 
shortening of the cervix is perceptible to the touch after the 
fifth month ; the os uteri is directed more backwards, and 
there is a peculiar velvety feel about it. The neck continues 
to shorten until the ninth month, when it becomes 
obliterated, having been absorbed into the body of the 
womb. The feel of the os in the unimpregnated and in the 
pregnant state is different ; in the latter, it is more patulous 
than in the former. 

(c) The active motions of the child. — These can rarely be 
distinguished before the fifth month, after which they 
usually increase in strength, progressively. They are mani- 



438 MEDICAL JURISPRUDENCE. 

fested by placing the cold hand upon the surface of the ab- 
domen. These movements should not be confounded with 
intestinal movements caused by the escape of flatus from 
one portion of the bowels into another. Cases often occur 
in which the active motions of the child are scarcely 
perceptible. 

{d) Pulsation of the foetal heart. — This is a certain and 
unequivocal proof of pregnancy, when it can be positively 
and repeatedly determined. The sound resembles the tick- 
ing of a watch ; it is a double sound, not synchronous with 
the mother's pulse, and counting from 150 to 120 per 
minute, according as pregnancy advances. It is heard over 
different parts of the abdomen, but preferably between the 
ilium and the umbilicus, on either side. At times it maybe 
inaudible, owing to a change in the position of the child. 
This sound may often be heard as early as the fifth month, 
but it becomes more distinct as pregnancy advances. 

{e) Other foetal soinids. — These are the uterine and innbilical 
souffle. The first is a peculiar blowing or whistling sound, 
audible over most of the abdomen, and believed to be due to 
the passage of the blood through the uterine arteries, or the 
placental vessels. It is synchronous with the pulse of the 
mother. It can be perceived as early as the tenth week, 
but better at a later period, up to the end of the seventh 
month. It is not an important sign of pregnancy, inasmuch 
as it may be heard in enlargement of the uterus from any 
cause, as by tumors, etc. 

The second or umbilical sound is attributed to the circu- 
lation through the umbilical vessels. It is more difficult to 
distinguish than the other sound, and is of little diagnostic 
importance. It is a single bellows murmur, synchronous 
with the pulsations of the foetal heart, and is heard over a 
very limited space, and is best distinguished in cases where 



UNCONSCIOUS PREGNANCY. 439 

the cord is wound round the body of the child. With all 
the above signs at command, it is safer not to give a positive 
opinion in a case of suspected pregnancy before the sixth 
month. 

The Corpus Luteuni will be described post. 

Instances of precocious pregnancy are mentioned by 
various writers, occurring as early as in the eleventh and 
twelfth years among the women of India and Abyssinia, 
and occasionally even in temperate climates. The earliest 
period of pregnancy that we find recorded is mentioned by 
Dr. Tidy {Leg. Med., vol. II), as given by Mr. Lefevre {Gaz. 
Hebdom), of a girl who menstruated at four years and be- 
came pregnant at eight years. Another case is mentioned 
in the Lancet (April, 1881), in which pregnancy occurred at 
eight years and ten months, and where the child at birth 
weighed seven pounds. Another similar instance is quoted 
by Wharton and Stille {Med. Jurisp., 1884, vol. II, p. 154), 
where menstruation commenced in the first year and preg- 
nancy in the ninth. The child at birth weighed seven and 
three-quarter pounds. 

Instances of late pregnancy are recorded, often as late as 
fifty years, and a case of twins at sixty-four years. 

The question whether a woman may become pregnant 
unconsciously must be answered affirmatively, when it is 
remembered that women are not unfreqyently raped when 
in an unconscious state through narcotism, or the anaesthesia 
produced by ether or chloroform, and pregnancy may result 
from such an intercourse, as is well known. But that a 
woman should be unconscious both of the fact of 
sexual intercourse, and also continue unconscious of the 
resulting pregnancy up to the birth of her child, we decline 
to believe, unless she was feeble-minded or idiotic. Cases 
of this character frequently occur in unmarried females, who 



440 MEDICAL JURISPRUDENCE. 

are wont to protest most earnestly their utter ignorance of 
the whole affair, and who pretend to ascribe the pangs of 
labor to colic or some other disorder; and who, when the 
child is shown them, will positively deny all knowledge of 
its origin! 

With married females, the case is quite different. With 
them unconscious pregnancy is a very possible occurrence. 
Many instances might be adduced of married women who, 
having had no children for several years, on becoming 
actually pregnant, refused to recognize their true condition, 
ascribing their increase of size to dropsy, or some other 
disorder. 

Cases may occur when it may become necessary to ascer- 
tain the fact of pregnancy in the dead, as, e. g., to determine 
the identity of a body, and to rescue the reputation of the 
deceased from the charge of unchastity. It should be 
remembered that the unimpregnated uterus resists putrefac- 
tion longer than any other organ of the body. Casper 
mentions the case of a young woman whose body was 
found, nine months after her disappearance, in the soil of a 
privy, every part completely decomposed, except the uterus, 
which was firm and perfect, and which, when examined, 
proved to be in the unimpregnated state. This circum- 
stance was of the greatest medico-legal consequence, as it 
served to rebut the charge of seduction and murder against 
a young man, who had been suspected of foul play. 

On the other hand, the discovery of a foetus (or a mole) 
in the uterus of the deceased is, of course, decisive proof 
of pregnancy ; and even years after interment, provided the 
foetus has reached the period of ossification, traces of its 
bones may be discovered among the bones of the mother. 



CRIMINAL ABORTION. 441 



CHAPTER XXXIV. 

CRIMINAL ABORTION, OR FCETICIDE. 

DEFINITION. — FREQUENCY OF ABORTION FROM NATURAL CAUSES. — 
PROOFS THAT A FCETUS HAS BEEN DESTROYED. — SIGNS AFFORDED 
BY THE MOTHER. — AGE OF THE FCETUS. — THE MEANS EMPLOYED. 

Criminal Abortion is the unlawful producing the expul- 
sion of the foetus (usually immature) from the womb of the 
mother. The term abortion, or miscarriage, is understood, 
in medicine, to express the expulsion of the foetus before the 
sixth month of gestation, or before it is considered viable ; 
after this period, it is said to be a premature labor. In law, 
however, no such distinction is made, the expulsion of the 
contents of the uterus at any period being considered an 
abortion. 

It is not necessary here to discuss the question, at what 
period of utero-gestation does the foetus become endowed 
with life ? We maintain very decidedly the doctrine, that 
it acquires vitality from the time of the impregnation of the 
ovum. The fact that it evinces no palpable signs of life be- 
fore quickening is no proof whatever of the absence of life; 
it merely shows that the life is extremely feeble in that early 
stage of its being. If it did not possess life from its be- 
ginning, it would be difficult, if not impossible, to account 
for its progressive growth and development in the uterus. 

Formerly, the laws of most countries recognized a dis- 
tinction between an abortion produced before' and after 
quickening, awarding a much milder punishment to the 
former than to the latter. The more recent laws of the 

20 



442 MEDICAL JURISPRUDENCE. 

United States and Great Britain recognize no such dis- 
tinction in regard to the criminahty of the act, in relation 
to the time of its commission. But cases of foeticide, al- 
though extremely common, very rarely become the subject 
of a criminal trial, unless they have resulted in the death of 
the woman, in which case it is regarded as murder. 

Before considering the medico-legal bearings of the sub- 
ject, it will be proper to advert to the fact that abortion very 
frequently occurs from natural causes. With some women 
it seems to be habitual, every pregnancy resulting in a mis- 
carriage in the early months of gestation, and this in spite 
of every effort on their part to prevent it. This tendency to 
abort is greatest at the menstrual periods. It is dependent, 
either upon causes affecting the mother, or the foetus and 
its membranes. Among the former, may be mentioned cer- 
tain constitutional diseases, as syphilis, smallpox, fevers, 
albuminuria, etc. ; also excessive passions, poisons, etc. 
Among the latter, death of the ovum, or disease of the 
placenta and membranes. The question whether a natural 
tendency to abort would mitigate the criminality of the act 
of producing it, where it resulted in the death of the 
woman, we believe, should receive a negative reply. 

The two leading medico-legal questions in every case of 
foeticide are : First, has the foetus in utero been actually 
destroyed, and what are the evidences ? Secondly, has this 
been brought about by natural (including accidental) causes, 
or by artificial (or criminal) means ? 

I. What are the proofs that a foetus has been destroyed ? 
These are derived (i) from an inspection of what has been 
expelled from the uterus, and (2) from an examination of 
the reputed mother. 

(i) By an inspection of what has been expelled from the 
uterus, we can discriminate between a true foetus and other 



CRIMINAL ABORTION MOLES. 443 

bodies, such as hydatids, moles, polypi and membranes. 
The age of the foetus may also be fixed with tolerable accu- 
racy. As regards the nature of the other substances, besides 
a foetus, which may be expelled from the womb, it may be 
remarked that the true hydatid is exceedingly rare, its exist- 
ence even being denied by high authorities. The hydatidi- 
form, or vesicular 7nole is of quite frequent occurrence ; it 
arises from a diseased condition of the villi of the chorion ; 
these become infiltrated with serum, and hang in masses 
like bunches of grapes. These growths are unquestionably 
the result of impregnation. 

Moles are also the result of a diseased condition of the 
membranes, or placenta. The fieshy mole is composed of 
layers of fibrous matter enclosing a central cavity, in which 
sometimes fragments of the embryo may be seen. It would 
seem to result from hemorrhage into the chorion. In the 
fatty mole there has also been an early death of the foetus, 
with fatty degeneration of the placenta. A withered foetus 
may often be observed, connected with the diseased pla- 
centa. Both these varieties of moles are positive evidences 
of pregnancy. 

Other substances besides the above maybe expelled from 
the uterus, which are ?iot the results of impregnation, such 
as false membranes, the product of dysmenorrhoea, and also 
polypi. All these, of course, should be subjected to the 
most rigid microscopic examination before an opinion is 
ventured, and lest an unwarranted imputation be formed 
against the character of the woman. 

A fact of some medico-legal importance in connection 
with this- subject is, that natural abortion usually occurs 
about the third or fourth month, and the ovum is nearly 
always expelled entire, i. e., the membranes not ruptured. 
But as criminal abortion is usually produced about the same 



444 MEDICAL JURISPRUDENCE. 

time, by perforating the membranes, of course, the fcetus 
would, In that case, be expelled first, and the placenta and 
membranes afterwards. This latter circumstance might aid 
materially in the diagnosis of the case. 

(2) The signs of an abortion deduced from an examination 
of the reputed mother. These signs are by no means satis- 
factory, especially if the abortion has occurred in the early 
months of gestation. The discharges of blood and the 
relaxed condition of the vagina might easily be ascribed to 
menstruation, and the somewhat open state of the os uteri 
might merely indicate some disease of that organ. Hence, 
a woman may more readily conceal her condition in the 
early, than in the later months of pregnancy ; but in propor- 
tion as it approaches the full term, the signs of the abortion 
become more definite, resembling those of delivery, and 
which will be discussed hereafter. 

When, however, death has followed within three or four 
days the attempt to procure the abortion, the case may 
usually be made out satisfactorily ; but if the woman sur- 
vives three or four weeks, it will be almost impossible to 
determine It by the autopsy, since all the usual signs will 
have disappeared ; and this is especially true where the 
abortion has occurred in the early stage of pregnancy. 

In a fatal case of criminal abortion, the first duty of the 
physician is to ascertain how far this Is to be ascribed to the 
means employed. For this purpose, he should most care- 
fully examine the vagina and uterus for marks of injury by 
the use of Instruments. Wounds on the walls of the vagina 
would Indicate the use of instruments by an Inexperienced 
hand ; whilst perforations of the neck of the Womb, and 
sometimes of its fundus, indicate the use of pointed Instru- 
ments, very possibly In the hands of a professed abortionist. 

In some instances, a blunt instrument, hke a male catheter, 



CRIMINAL ABORTION INSPECTION. 445 

is employed ; and in a case that lately came under the 
author's observation, the attempt to perforate the mem- 
branes seemed to have failed, while the instrument employed 
passed up between the membranes and the uterine walls, 
and tore the placenta, producing fatal hemorrhage. In 
cases of instrumental violence, there will frequently be dis- 
covered marks of metritis and peritonitis. The stomach and 
bowels should always be carefully inspected for signs of 
irritant poisons, such as redness, and the remains of the 
various reputed abortives, as powdered cantharides, tops of 
savin, ergot, etc., also the oils of savin, tansey, pennyroyal, 
etc.; the latter may sometimes be recognized by the odor; 
or they may be separated by distillation, or by ether. 

In all fatal cases of foeticide, the examiner should care- 
fully examine the condition of the uterus and its appendages, 
so as to form, at least, an approximative estimate of the 
period of the pregnancy. The uterus in the unimpregnated 
(normal) state, measures (according to Montgomery), about 
two and a half inches long, one and three quarter inches 
broad, and one inch thick. Its size, of course, gradually 
increases as pregnancy advances, according to the following 
average : very little change occurs during the first month. 
During the second month, it enlarges considerably. At the 
end of the third month, its length is five inches, of which one 
inch is for the cervix. At the end of the fourth month, it is 
five inches long from the fundus to the beginning of the 
cervix. At the end oi five months, its length is six inches. 
At six months, the length is seven inches. At seven months, 
it is eight inches. At eight months, it is nine to nine and a 
half inches. At nine months, it is ten and a half, to twelve 
inches in total length. 

If death should occur from hemorrhage at full term, no 
contraction of the womb will have taken place; but if the 



446 MEDICAL JURISPRUDENCE. 

woman survive for a few days, there will always be more or 
less contraction of that organ. In two days after delivery 
(at full term), the womb will have contracted down to seven 
inches in length, and four in width ; after one week, it will be 
about five or six inches long and two wide ; after two weeks, 
the length is four or five inches, and the width one and a 
half inches. At the end of the second month, it will have 
attained its normal size. 

Its shape also changes, as well as its size. In the unim- 
pregnated state, it is flat, pyriform and somewhat triangular. 
After impregnation, it assumes somewhat of a globular shape ; 
but no change of consequence occurs in the cervix until 
about the fifth month, after which it progressively shortens, 
losing one-fourth its length in the sixth month ; another 
fourth in the seventh month ; still another fourth in the 
eighth month; and at the close of the ninth month, or full 
term, becoming entirely obliterated, so that, at this period, 
the shape of the uterus is ovoid. 

The thickness of its walls at full term is about that of the 
unimpregnated condition — one-third to two-thirds of an 
inch ; but in a few hours after delivery, under contraction, 
its thickness increases, often to two inches. 

The uterine vessels undergo very considerable enlargement 
in pregnancy — especially the veins, which attain such di- 
mensions as to be denominated sinuses, at the position 
where the placenta is attached.. The ligaments of the uterus 
likewise share in the general change. The broad ligaments 
become gradually effaced, in consequence of being absorbed 
(so to speak) in the increased development of the uterus. 
The round ligaments increase in thickness. Both become 
extremely vascular. 

The Fallopian tubes increase in size, become less convo- 
luted, and are much more vascular. Usually that one 



CRIMINAL ABORTION DEVELOPMENT OF THE FCETUS. 447 

through which the ovum has passed is somewhat the largest. 
The ovaries also share in the general increased vascularity. 
That one from which the ovum escaped displays a peculiar 
fullness or prominence at one portion of the organ. If this 
be cut open a yellowish-looking body will be observed, 
named corpus luteum^ which will be described more fully 
hereafter. 

It should not be forgotten that all the above signs of 
abortion may occur after the expulsion of hydatids and 
moles ; also, that a corpus litteum may be found in the 
virgin state. 

It will be proper here to describe the gradual development 
of the foetus, together with its appearance at the different 
stages of its growth, so as to furnish the data for establish- 
ing its probable uterine age. At the earliest period when 
the human embryo can be discerned (from fourteen to 
eighteen days), it presents the appearance of a floculent 
mass, of a semi-transparent, gelatinous consistence, about 
two and a half lines in length. 

In the third or fourth week, the length of the embryo is 
from four to six lines ; the weight twenty grains. Its form 
is curved, and already the rudiments of the several organs 
are visible in the shape of dots and protuberances. At the 
end of the eighth week, the length is fifteen to eighteen lines ; 
the weight, two to five drachms. The head forms more 
than two-thirds of the body; the features are more dis- 
tinguishable, and the sex may sometimes be made out. At 
the end of the twelfth week (three months) the length is two 
and a half to three inches ; weight one to two ounces. The 
whole ovum is now about the size of a goose ^gg. The 
fingers are separated, but the toes not ; the genital organs 
very prominent. At the end oi four months, the length is 
five to seven inches ; weight, six to seven ounces. The skin 



448 MEDICAL JURISPRUDENCE. 

rosy, very delicate and covered with a fine down ; hair on 
the head short and silvery. Now, the disproportionate 
quantity of the liquor amnii disappears, and the foetus nearly 
fills up the cavity of the uterus. At the end of y^z'^ months, 
the length is from eight to ten inches ; weight, eight to ten 
ounces ; nails distinct ; the head, liver, heart and kidneys 
disproportionately large. If abortion occurs now, the mem- 
branes are usually first ruptured, and the foetus escapes. 

At the end of the sixth month the length is about twelve 
inches ; weight, about one pound, or over. The color of the 
body is of a cinnabar-red ; down and sebaceous matter cover 
the skin ; umbilicus a little above the pubis ; fat in small 
quantities under the skin ; head very soft ; fontanelles widely 
separated ; palms of hands and soles of feet purplish ; 
scrotum empty; labia project, but do not conceal the clitoris; 
the membrana pnpillaris still distinct ; nails distinct ; me- 
conium, in small quantity, in the large intestines ; bladder 
hard and pyriform, with a very small cavity. At the end of 
the seventh month, the length is fourteen to fifteen inches ; 
weight, two to four pounds. Skin of a dirty-red color; hair 
on the head about half an inch long ; membrana pupillaris 
disappearing ; eyelids no longer adherent ; nails more firm ; 
convolutions begin to form on the brain; meconium is more 
abundant; the ears lie close to the side of the head. If the 
child should now be born, the arms and legs will be bent in 
the position they maintained in the womb. 

At the end of the eighth month, the length is fifteen to 
sixteen inches ; weight, three to four pounds. The skin is 
thicker and more natural, and is covered with a fine, soft 
hair ; hair on head is darker ; nails firmer ; breasts, often 
projecting; the testes still at the rings, but often one (the 
left) is found in the scrotum ; lungs are reddish ; liver, still 
very large ; membrana pupillaris disappeared. At the end of 



CRIMINAL ABORTION DEVELOPMENT OF THE FCETUS. 449 

the ninth month, the length is eighteen to twenty inches ; 
weight (average) seven pounds ; ossification more complete ; 
bones of cranium touch each other; fontanelles, smaller ; hair 
on head longer and darker ; nails more solid, and prolonged 
to the ends of the fingers ; convolutions of brain more 
numerous; lungs redder and more voluminous; meconium 
nearly fills the whole intestine; bladder contains urine; both 
testes descended, and vulva closed. 

In the development of the foetal brain, its form and dis- 
position, as also that of the spinal cord, can be recognized 
as early as the eighth week. In the third month, the tuber- 
cula quadrigemina, optic thalami and corpora striata are 
seen ; the medulla oblongata can be distinguished about the 
sixth or seventh month. The cineritious portion is not 
formed until nearly the end of the ninth month. The 
weight of the foetal brain, as stated by Wenzels, is — at five 
months, 720 grains ; at eight months, 4960 grains ; at nine 
months, 6150 grains. 

The point of insertion of the umbilical cord will aid in 
determining the age of a foetus, when about its full term. 
From numerous observations, the conclusion arrived at is, 
that at full term the cord is inserted a few lines below the 
middle of the body ; earlier than this, the point of insertion 
is at the centre. Prof Moreau's observations, at the Mater- 
nite of Paris, show, that out of five hundred cases at full 
term, in only four was the umbilicus exactly in the centre 
of the body ; in all the rest, it was from eight to ten lines 
below it. 

Beclard and others have pointed out a very certain test 
of the age of the foetus about the full term, viz., the osseous 
deposit in the inferior epiphysis of the femur. If there is 
no visible trace of this, the foetus cannot be over eight 
months ; if it has the size of a hemp seed (half a line), it is . 
20* 



450 MEDICAL JURISPRUDENCE. 

in the ninth month ; and if from two to three hnes in 
diameter, it has arrived at full term ; if more than three 
lines, the child has probably lived after its birth. 

The weight of children born at the full term varies very 
considerably. As already stated, the average weight may 
be taken at about seven pounds, — rather less in females ; but, 
in many instances, the weight far exceeds this. Dr. Owens 
mentions one that weighed seventeen and three-quarter 
pounds, and that measured twenty-four inches in length. 
Dr. Meadows gives one that weighed eighteen pounds and 
two ounces, and measured thirty-two inches. Dr. Donellan, 
of Louisiana, mentions a case of triplets, of which one 
weighed nine and a half pounds, one seven and a half 
pounds, and one seven pounds, the united weight being 
twenty-four pounds. On the other hand, children at full 
term often fall below the average, weighing only from four 
to six pounds. 

II. The second medico-legal question is, Was the abor- 
tion produced by natural, or by artificial {criminal) means ? 
The examination of the reputed mother, especially if death 
has resulted, would generally settle this question satis- 
factorily. But it will be proper here to point out the various 
means that are generally resorted to in order to effect the 
purpose. These criminal means may be considered under 
the heads of (i) general 2S^^ (2) special means. And here 
it may be premised that, as an almost universal rule, where 
there is no constitutional predisposition on the part of the 
woman to abort, this process can very rarely be effected 
except by mechanical interference. Hence, the violent 
measures which are sometimes resorted to by women to 
accomplish it. Many cases are reported where severe 
bodily injuries have been inflicted on the woman with a view 



CRIMINAL ABORTION — MEANS EMPLOYED. 451 

to bring on an abortion, but without the desired result. The 
most violent exercise, and the most brutal violence have 
been submitted to without success. 

I. The general means include repeated blood-letting, 
emetics and drastic purgatives. As regards venesection, it 
often acts as the most effectual means of preventing it in 
plethoric women ; nevertheless, if it could be shown, in a 
case of abortion, that the female had previously resorted to 
frequent bleedings, this fact might be received as presump- 
tive evidence against her. The same is true in the case of 
the employment of leeches. 

The above remarks are also applicable to the use of 
emetics. Although violent vomiting might bring on prema- 
ture labor in the last stages of pregnancy, in feeble women, 
it can have no effect in the earlier months. The well known 
nausea and vomiting (the latter sometimes quite violent) of 
pregnancy are never known to produce miscarriage. 

The drastic cathartics are often resorted to for the same 
purpose, and they may possibly effect it in weakly women, 
especially if predisposed to miscarriage ; but as a general 
rule, they are powerless to this end. 

II. The special means employed comprise the use of certain 
drugs which are supposed to possess the power to excite 
uterine contraction, and are therefore named emmenagogiies 
and abortives ; and also the use of instrumental measures for 
the purpose of puncturing the membranes, and so inducing 
uterine contraction. The number of the popular abortives 
is very considerable ; only a few need be noticed here. 

Ergot, or Spurred Rye undoubtedly possesses ecbolic 
properties ; that is, it is capable of causing contractions of 
the uterus during labor, but it is not certain that it can 
affect this organ in the earlier stages of pregnancy. It is 



452 MEDICAL JURISPRUDENCE. 

certain that it very often fails to bring on miscarriage, 
although large and repeated doses have been taken. 

Cotton root {Gossypiuni herbaceuni) has a wide repu- 
tation among the colored population of the South as an 
abortive. It is even said to be more certain and powerful 
than ergot. 

Savin (tops of Juniperus sabina), is highly esteemed as 
an ecbolic. Its virtues depend on a volatile oil (oil of savin), 
which is also much employed as a popular abortive. Savin 
is a powerful irritant to the stomach and bowels. The oil 
has frequently caused death through peritonitis and gastritis, 
without discharging the foetus. It is an exceedingly dan- 
gerous remedy. Tansy, pennyroyal and rue all act in a 
similar manner ; they each contain a powerful volatile oil, 
which is considerably used as an abortive, but in the 
majority of cases without any result. They frequently pro- 
duce the death of the woman through their violent irritant 
action. Various other substances are employed as abortives, 
such as cantharidcs, sulphate of copper, seneka, cimiciftiga, 
iodide of potassium, mercury, etc. Of one and all of the 
above reputed abortives it may be affirmed, without contra- 
diction, that they are uncertain in their operation on the 
uterus ; that they always endanger the mother's life ; and 
that they not unfrequently destroy the mother, without 
effecting the discharge of the foetus. 

The special means also comprise blows and violent pres- 
sure made upon the abdomen, loins and back of the woman. 
Occasionally, but by no means always, such procedures may 
result in the expulsion of the foetus, but they necessarily 
entail great risk of life to both mother and child. The use 
of pointed instruments introduced into the uterus so as to 
rupture the membranes, is the only certain method of pro- 



CRIMINAL ABORTION MEANS EMPLOYED. 453 

ducing uterine contraction, and insuring the expulsion of its 
contents. This operation in the hands of empirics, or of the 
female herself, is often followed by very serious and fatal 
consequences, from wounding, and even perforating the 
womb. Other methods are sometimes employed, as the 
injection of warm water between the uterus and ovum, and 
the dilatation of the os uteri by means of sponge and other 
tents, or by the use of Barnes' dilator, A case is mentioned 
by Dr. Channing, where a bent wire was introduced into the 
uterus, where it became entangled in the tissue, and had to 
be cut off; the piece remained within for six years, and 
singular to remark, the case was one of merely suspected 
pregnancy. In another case, strong sulphuric acid was 
injected into the vagina for the purpose of bringing on 
abortion. The result was violent inflammation, causing 
adhesion of the walls of the vagina, and also of the bladder. 
The Caesarean section was finally performed, which termi- 
nated fatally. 

Before leaving this subject, it is proper to state that the 
operation for abortion may sometimes become necessary in 
regular medical practice, and when, of course, its perform- 
ance is legitimate and proper. The cases demanding it are 
deformity of the pelvis to such an extent as to preclude the 
possibility of delivery of a living child at full term, and 
possibly where the vomiting during pregnancy is of such a 
violent and continued character as actually to endanger the 
mother's life. In every such case, however, the practitioner 
will do well to secure a consultation before venturing to 
perform the operation. 

Abortion may sometimes h^ feigned iox sinister purposes, 
such as to secure compensation for an alleged seduction and 
consequent pregnancy, or to excite sympathy and aid. In 



454 MEDICAL JURISPRUDENCE. 

such cases, a thorough examination of the woman and the 
alleged foetus will serve to clear the matter up. 

Legally considered, the criminality of abortion is not 
affected by the fact that the woman was not really pregnant, 
nor by the birth of monstrosities or of moles, nor by the 
fact of an extra-uterine pregnancy. 



INFANTICIDE. 455 



CHAPTER XXXV. 

INFANTICIDE. 
SECTION I. 

DEFINITION. — A LIVE BIRTH. — I. QUESTIONS RELATING TO THE IN- 
FANT. — WAS IT BORN ALIVE? — SIGNS OF DEATH BEFORE BIRTH. 
— PROOFS OF A LIVE BIRTH DERIVED FROM THE LUNGS. — THE 
HYDROSTATIC TEST. 

By Infanticide is understood the criminal destruction of 
the new-born child. In a legal sense, it is immaterial whether 
the child is killed immediately after its birth, or a few days 
subsequently. 

The crime of infanticide has been fearfully prevalent 
throughout the world, from the remotest period of history. 
Before the establishment of Christianity, it was legalized 
among the most enlightened and cultivated nations of the 
earth ; and even at the present day, its practice is scarcely 
diminished in the most civilized countries, although placed 
under the ban of the law, and confined almost exclusively 
to the destruction of illegitimate children. Child murder is 
not regarded by the law as a specific crime ; it is treated like 
any other case of homicide, and is tried by the usual rules 
of evidence in cases of murder. Nevertheless, there is this 
important difference in the nature of the medical evidence 
required, namely, that it must prove satisfactorily that the 
child was born alive ; in other words, the burden of proof 
that a living child was destroyed is thrown upon the prose- 
cution. The law humanely assumes that every child is born 
into the world dead, until the contrary is shown, because so 
many children do thus actually come into the world, and 



456 MEDICAL JURISPRUDENCE. 

many others die very soon after, from various causes ; and 
in the latter, the signs of their having hved are frequently 
indistinct. As the charge of infanticide can never be sus- 
tained unless there is distinct proof that the child was legally 
alive at its birth, great difficulty is usually experienced in 
obtaining sufficient evidence to convict a woman accused of 
this crime. As a general rule, she has been delivered in 
secret, with no witness of the birth ; and the body of the 
child is frequently concealed or destroyed. There is, besides, 
a general reluctance on the part of a jury to convict a woman 
of willful murder for this crime, horrible as it is, on account 
of a feeling of sympathy for the prisoner. 

The term '* born alive," in the legal sense, implies the 
complete expulsion of a living child from the mother. A child 
is not "born," legally, if any portion of its body — a leg, for 
instance — is retained within the vulva. Hence, through a 
figment of the law, the destruction of a living child, if only 
partially born, is not regarded as murder ! It is not, how- 
ever, necessary that the umbilical cord should be cut, in 
order to come within the meaning of the statute. 

In the majority of cases of infanticide, the child has ar- 
rived at the full term of gestation ; but, as children are often 
born at an earlier period — either naturally, or by artificial 
means — the examiner should be prepared, from the inspec- 
tion of the body, to give an opinion as to the probable age 
that the child had attained in utero. For this purpose he 
should be acquainted with the general appearance, size and 
development of the foetus at the different periods of its 
uterine life {z>id. ante, p. 445). 

In a case of infanticide, the medico-legal questions in- 
volved pertain, first, to the infant, and secondly to the 
reputed mother. 

I. Questions relating to the infant: (i) Was it born 



INFANTICIDE SIGNS OF BIRTH. 457 

■ alive ? (2) What was the cause of its death ? (3) Its age ? 
(4) The interval since its death ? 

(i) Was it born alive? The general appearance of the 
body of an infant that was born ahve, at full term, and had 
breathed, may be described as follows : The remains of the 
sebaceous matter {vernix caseosd) will usually be found under 
the armpits and behind the ears ; the hair will be dry and 
clean ; the ears do not lie so close to the side of the head 
as in dead-born children; the eyes remain half open, in spite 
of all efforts to close them ; the caput succedaneum, or swell- 
ing on the back of the head, is much more distinct than in 
the still-born child ; the former contains a glutinous, bloody 
serum, while in the latter there is only a small quantity of 
colorless liquid. The thorax is more arched, and the dia- 
phragm more depressed, than in the case of the still-born. 
According to Casper, the highest level of the diaphragm in 
the still-born child is between the fourth and fifth ribs, whilst 
it descends to between the sixth and seventh in the living. 
The lungs will also present unmistakable evidences, which 
will be described hereafter. 

A dead-born child, having perished immediately before its 
birth, will usually be found more or less covered with the 
vernix caseosa ; its hair closely agglutinated; ears lie 
closely to the side of the head ; eyes closed, and eyelids, 
when raised, do not remain open; mouth closed, and a drop 
of watery blood is often seen trickling from the nostril. The 
thorax appears flat and unexpanded; the trachea is flattened, 
and often contains a viscid, mucous secretion. The lungs lie 
in the posterior part of the thorax; they are of a brownish- 
red color, have a granular structure, and do not crepitate 
upon pressure ; their length is greater than their breadth, 
and their edges are rounded. The remnant of the umbilical 



458 MEDICAL JURISPRUDENCE. 

cord has a fresher look than in a child that has lived for a 
few hours. 

If the death of the foetus has occurred some time before 
its birth, there will be the following signs of i7ttra-uterine 
putrefaction : The body is extremely flaccid and flattened, 
as if it had been macerated in water ; the skin is spotted, 
and the cuticle detached in many places, especially on the 
abdomen ; the head lies perfectly flat in any position ; the 
bones of the cranium move easily on one another ; the face 
is flattened, and the features distorted. The cellular tissue 
and cavities are infiltrated with a bloody serum ; the viscera 
are easily loosened from each other; gas is developed in the 
lungs and liver. The color of the lungs is dark brown. 
There is an absence of the usual odor, and also of the green 
color, of ordinary putrefaction. 

It is important to have clear and definite ideas concerning 
the proofs of a live birth ^ in cases of infanticide. It is well 
known that many children come into the world still-born, 
that is, without giving any sign of life, and yet, by proper 
attention, they subsequently do revive, and continue to live. 
From this, it is to be inferred that respiration is not the only 
evidence of a live birth. Nevertheless, in the cases of in- 
fanticide that come under judicial investigation, in which 
the proofs of a living birth are to be discovered solely by 
an inspection of the dead body of the child, the fact of 
respiration is the one main proof to be established by the 
examiner. If this fact can be satisfactorily proven, there 
can be no doubt that the child had lived; but it does 
not necessarily prove that it was born alive, since it might 
have perished (naturally or otherwise) before it was actually 
born, in the legal sense. Again, a child may live for several 
hours after its birth, breathing very feebly ; and after its 
death the air cells of the lungs may present no evidence of 



INFANTICIDE PROOFS OF RESPIRATION. 459 

distention; so that, judged by this single sign presented 
after death, the child would be said to have been born 
dead. 

As to the question whether any evidences of life before 
respiration can be discovered in the dead body, in a case of 
infanticide, the answer must be that, at present, there are no 
satisfactory medical data to enable us to express a positive 
opinion in such cases — certainly not from a mere inspection 
of the lungs. Should there, however, be other evidence, 
such as marks of great violence upon the body, or proofs, 
through witnesses, that respiration had been designedly pre- 
vented, either by the woman herself, or by an accomplice, 
such circumstances would certainly afford very strong moral 
presumption of murder ; but they could never, in our 
opinion, lead a jury to convict the woman, in the absence of 
all signs of respiration in the lungs. Dr. Causse {Ann. d' 
Hyg., Nov., 1878), quoted by Taylor {Med. Jnrisp., Am. ed., 
p. 602), contends that a true eccJiyniosis found on the body 
of a new-born child is a positive proof that the blood was 
circulating at the time, and that it had been extravasated, 
which could only occur in a living body, and that this proof 
would be strengthened where the blood was found coagu- 
lated and the surrounding tissues deeply infiltrated. Devergie 
held a similar opinion in relation to the significance of 
ecchymoses, and infiltration of blood. Still, while fully ad- 
mitting the force of these proofs of vitality as good medical 
evidences, we do not believe they would be received by a 
jury as sufficient of themselves to establish the charge, since 
they are open to the objection that the injuries might have 
been inflicted during birth, or accidentally afterbirth. 

Proofs that the child has breathed. — These proofs are de- 
rived (i) from the organs of respiration ; (2) from the organs 
of circulation ; (3) from the abdominal organs. 



460 MEDICAL JURISPRUDENCE. 

I . Proofs afforded by the respiratory orga?is. 

(a) The thorax is higher, or more vaulted in appearance 
than where the child has not breathed ; its capacity is 
increased; but the attempt to indicate these changes by 
actual measurements and comparisons, cannot be depended 
upon, on account of the natural difference in the size of the 
thorax in different children at birth. 

(fi) The diaphragm is considerably more depressed after 
respiration has been established than before ; according to 
Casper (as already mentioned), in children born dead its 
highest point reaches between the fourth and fifth ribs ; 
whereas, in those born alive and fully respiring, it descends 
to between the sixth and seventh ribs. The position of the 
diaphragm may also be affected by the gases produced 
during putrefaction. 

{c) The larynx, before breathing, is narrower, contains 
more or less mucus, and is closely approximated to the 
epiglottis ; after respiration it is wider, and is not closed by 
the epiglottis. 

{d) The situation and volume of the lungs. — Before breath- 
ing, these organs are placed far back in the thorax, so as 
almost to escape notice. After complete respiration, they 
project forward so as completely to fill the cavity of the 
chest, and cover, and to a great extent conceal, the heart and 
pericardium. If respiration has been imperfect, the volume 
of the lungs is proportionately less developed. 

(e) The consistence of the lungs. — Before respiration, they 
have a firm and compact feel, and they are of the consistency 
of liver ; after full breathing, they are spongy and crepitant 
to the feel. When cut, there is an escape of blood-froth ; 
and when pressed between the fingers under water, air 
bubbles will rise to the surface. A thin section, when ex- 
amined by the microscope, will show distinct air-cells. It 



INFANTICIDE THE STATIC TEST. 461 

must, however, be remembered that the lungs of infants that 
have Hved a considerable time after birth, but that have 
breathed very imperfectly, will sometimes not crepitate 
under the finger, nor will they float on water. 

(/) Their color. — Before respiration, this is bluish-red or 
violet, resembling that of the spleen. A short exposure to 
the air will render the color brighter. After full respiration, 
their color changes to a pale red, becoming bright scarlet 
after free exposure to the air, or else irregular bright spots 
appear upon a bluish-red ground, giving them a marbled 
appearance, a peculiarity which cannot be given to foetal 
lungs by artificial inflation. " This insular marbling of the 
lungs is characteristic of lungs that have breathed, and is 
due to the presence of blood in the vessels surrounding the 
inflated lung tissue" (Husband). In imperfect respiration, 
and as a result of disease, the color of the lungs may be 
much modified. 

(^) Their absolute weight, or the Static test. — The weight of 
the lungs before respiration is less than after that process 
has been established, owing to the presence of blood circu- 
lating in them. The average weight before respiration^ de- 
rived from nine cases, according to Taylor, was 649 grains. 
Dr. Traill gives it as varying from 430 to 600 grains. The 
average weight after respiration, in three cases, was 927 
grains. From these data, attempts have been made to insti- 
tute comparisons in unknown cases ; but so much depends 
upon the maturity or immaturity of the child, and the de- 
gree of respiration, that the test is unworthy of confidence. 
Great weight of the lungs cannot, of itself, furnish proof of 
respiration, unless accompanied by increase of volume from 
the presence of air, and by crepitation and the distention of 
the air-cells ; it may really be due to disease. Dr. Taylor 
relates a case where the lungs weighed upwards of 1200 



462 MEDICAL JURISPRUDENCE. 

grains ; they contained no air, and when cut into thirty 
pieces, not one floated on water. 

Ploucquefs test consists in comparing the absolute weight 
of the lungs with that of the body of the child. It is based 
on the fallacy that there exists an invariable relation be- 
tween the weights of the lungs and bodies of new-born 
children. But no such relation really exists. The varia- 
tions are so numerous as to render this test altogether 
useless. 

Specific gravity of the lungs. — This is greater before than 
after respiration ; because the air received in breathing 
throughout the air-cells more than counterbalances the ad- 
ditional weight derived from the blood circulating through 
them. Dr. Taylor found, as the result of several experi- 
ments, that the specific gravity of the lungs in the foetal 
state varied from 1.04 to 1.05 ; after respiration it was 0.94 
(one experiment). It will, of course, be understood that the 
specific gravity of the substance of the lungs remains un- 
changed ; it is only rendered apparently lighter by the in- 
troduction of air into the cells. The introduction of a very 
small quantity of air is sufficient to render the foetal lungs 
buoyant in water ; and it matters not whether this air is de- 
rived from respiration, artificial inflation, or putrefaction. It 
is on this property of the lungs that the application of what 
is termed the hydrostatic test is founded. 

The hydrostatic test — (docimasia pulmonum). — The prin- 
ciples involved in this test have just been noticed — the fact 
that the lungs in their foetal, or unaerated condition, sink 
when put into water ; whilst the lungs of a child that has 
breathed, or where they have been otherwise aerated, float 
in water. 

The mode of applying this test is very simple. Having 
carefully removed the lungs from the chest (usually along 



INFANTICIDE THE HYDROSTATIC TEST. 463 

with the heart and thymus gland), these should be put into 
a sufficiently capacious vessel containing distilled, or river 
water, at 60° F. If they are very buoyant, floating on the 
top of the water, this indicates very complete aeration of the 
lungs, and may be regarded as a strong proof of respiration 
at birth. If they are less buoyant, floating largely under the 
surface, the indication is that the aeration was not complete. 
Each lung should now be tried separately, to determine if 
each is equally buoyant. Then each one should be divided 
into about fifteen pieces, and each fragment separately tested. 
If all the pieces float, even after firm compression, the in- 
ference would be that respiration had been very perfectly 
performed. If they sink, it should be noticed whether this 
occurs rapidly, or slowly. The lungs should then be tested 
separately — one may sink, while the other (commonly the 
right) may float. Supposing both to sink, they should each 
be divided into pieces, and each one tried separately, as be- 
fore described. If all the pieces sink, the inference is that, 
although the child may have survived its birth for a short 
time, there is no evidence of its having breathed. 

Much useless discussion has occurred as to the true value 
of the hydrostatic test in a case of infanticide. It must be 
evident, on a careful consideration of the principles involved 
in this test, that it can only prove the aeration, or the non- 
aeration of the child's lungs ; it does not necessarily prove 
respiration, although it establishes a very strong probability 
of it. Moreover, as respiration may take place — partially, 
at least — as in certain cases of face presentation, where the 
labor has been protracted, and the vagina widely dilated — 
while the head was yet in the uterus, or iii the vagina^ and 
frequently after the head has been born, but before the com- 
plete extraction of the body, it follows that the hydrostatic 
test can never actually prove a live birth, but merely that the 



464 MEDICAL JURISPRUDENCE. 

child had breathed, and therefore was ahve at or about the 
time of its birth {vid. ante, p. 456). 

Two objections have been offered against the hydrostatic 
test, which deserve notice. 

Objection I. That the lungs may float although the child 
7nay not have breathed — {a) from artificial inflation ; (b) from 
putrefaction ; (c) from emphysema. 

[a) Artificial inflation. — In reply to this objection it may 
be stated that it is extremely difficult to distend the whole 
lung artificially through the mouth, even if a tube and bel- 
lows be employed ; most of the air will be found to have 
passed into the stomach. Besides, the force of the objection 
seems to be met by the fact that, in a case of child murder, 
the great object of the woman and her accomplices is to 
make it appear that the child was born dead; they would, 
therefore, hardly be likely to adopt measures that would 
suggest a strong probability of a live birth. 

It must, however, be admitted that, while artificial infla- 
tion of the lungs can never be mistaken for perfect respira- 
tion, it might be confounded with imperfect breathing. In 
both cases, the lungs will be more or less buoyant ; they 
will crepitate under pressure; when divided into fragments, 
many of these will float on water ; and, in some exceptional 
cases, firm pressure made on pieces of a lung artificially 
inflated through a tube, has failed to cause these pieces to 
sink. As a general rule, strong compression on a fragment 
of lung artificially inflated by the mouth, will so completely 
remove the air as to cause it to sink in water; whilst no 
amount of force, short of an entire disintegration of tissue, 
will prevent the floating in cases where natural respiration 
has been fully performed. 

There are other points, however, to be noticed in making 
the diagnosis, viz., that artificial inflation does not increase 



INFANTICIDE THE HYDROSTATIC TEST. 465 

the actual weight of the lungs, like respiration, because it does 
not invite the blood into them ; and also that the color of the 
artificially-inflated lung is a uniform cinnabar-red, without 
any marbling. The explanation of this will be obvious on 
reflection. Natural respiration tends to create a vacuum in 
the lungs, and consequently to draw into them the blood of 
the pulmonary arteries, which gives them the comparatively 
dark bluish and marbled appearance alluded to ; but arti- 
ficial respiration, by which air is forced into the lungs, 
tends, by the pressure of that air, to exclude the blood, and 
consequently to render the color of the lungs still lighter 
than before. Casper's opinion about the matter is : " When 
we observe a sound of crepitation, without any escape of 
blood-froth on incision, laceration of the pulmonary air 
cells with hyperaemia, bright cinnabar-red color of the 
lungs, without any marbling, and perhaps air in the (arti- 
ficially inflated) stomach and intestines, we may, with 
certainty, conclude that the lungs have been artificially 
inflated" {For. Med., Vol. Ill, p. 6'^). 

{p) Putrefaction. — It is admitted that the lungs of a dead- 
born child will float, as the result of the gases generated by 
putrefaction. The air thus evolved is not contained in the 
air cells of the lungs, but in the cellular tissue, and chiefly 
between the lobes and lobules. Moreover, it collects in 
rows or bubbles, which are much larger than the air-vesicles, 
prominent, and entirely disappearing under slight pressure. 
At the same time, the lungs themselves present other 
evidences of putrefaction, such as a greenish color, a foetid 
odor, and diminished consistence. If a portion be cut out 
from the interior of the lung, it will be found to sink in 
water. Again, if the air be squeezed out of a portion of 
the lung, it will no longer float in water. There is also a 
want of crepitation in a putrescent lung. 

21 



466 MEDICAL JURISPRUDENCE. 

The exact period when the foetal lungs undergo putrefac- 
tion cannot be fixed; but it is known that it is delayed 
much longer than in the other organs of the child, conse- 
quently, in a doubtful case, if the other organs give no 
evidence of decomposition, we may be certain that the 
buoyancy of the lungs is not owing to putrefaction. After 
complete decomposition, the lungs again sink in water. 
There ought to be no difficulty in distinguishing between 
the buoyancy of respiration, from that resulting from putre- 
faction, in employing the hydrostatic test. 

(c) Emphysema. — This was formerly regarded as a dis- 
eased (congenital) condition of the lungs, which caused 
them to float in water, in the absence of respiration; but 
its existence is regarded as very questionable by the best 
authorities. Casper's very decided opinion is " that, as yet, 
not one single well-observed and incontestable case of em- 
physema developing itself spontaneously within the foetal 
lungs, is known ; and it is, therefore, not permissible, in 
forensic medicine, to ascribe the buoyancy of the lungs of 
new-born children to this cause " {For. Med., Vol. Ill, p. 72). 

Objection II. That the lungs may sink i7i water, although 
tJie child may have breathed and lived. 

{a) From disease, as pneumonia, congestion and atelec- 
tasis pulmonum. These would increase the density of the 
pulmonary tissue, and cause it to sink in water. But the 
two first conditions are extremely rare in the new-born 
child, and the latter is to be regarded as simply the original 
fcetal, undeveloped condition of the lung (Casper, Meigs). 
If ever found, they can be readily recognized by their gen- 
eral appearances, and also by dividing the lungs into pieces, 
and finding that some of the fragments will float. In the 
case of congestion, if a piece of the lung be squeezed, so 
as to remove the blood, it will be found to float. 



INFANTICIDE THE HYDROSTATIC TEST. 4G7 

(J?) In those cases where the child had survived for some 
time, but where the respiration was so feeble as not to in- 
flate the lungs, the hydrostatic test will generally, though 
by no means always, discover the presence of air in a few 
of the pieces of the lungs, when these have been divided. 
In the case where every fragment sinks, this test can, of 
course, render no assistance, a circumstance which is cer- 
tainly to be regretted, inasmuch as it does not permit us 
always to ascertain the truth. 

The general deductions from the two foregoing objec- 
tions are the following: — 

1. The lungs float (i) from natural respiration; (2) from 
artificial inflation ; (3) from putrefaction ; (4) from emphy- 
sema (possibly). Therefore the mere buoyancy of the lungs 
is not, of itself, positive proof of respiration ; but, with 
proper precautions, the test may be depended on. 

2. The lungs sink (i) from total want of respiration; 
(2) from feeble or imperfect respiration ; (3) from disease. 
Hence, the mere sinking of the lungs in water is not, of 
itself, a positive evidence that the child has not breathed ; 
but, with due precautions, it may be regarded as a safe 
test. 

As the hydrostatic test is of such importance in cases of 
infanticide, great carefulness should be observed in its em- 
ployment The chest should be properly opened, and the 
position, size, color, etc., of the lungs accurately noted. The 
great vessels at their roots are then to be tied and cut. 
The trachea is to be divided as close as possible to the 
lungs ; these are next to be taken out, together with the 
heart and thymus gland, and closely examined for disease 
or putrefaction, also for crepitation on pressure. A suitable 
vessel, containing pure or river water at 60° F. should be 
provided. It is important to attend to the temperature of 



468 MEDICAL JURISPRUDENCE, 

the water, since the density of this fluid, and consequently 
its buoyant power, vary considerably between 40° F. and 
212° F. For the sake of uniformity, therefore, the mean 
temperature of 60° should always be employed. For a 
similar reason fresh, and not salt, water ought to be used. 
The lungs, together with the heart, are then to be placed 
in the water, and it should be noticed whether, and how, 
they float or sink. (There seems to be no good reason why 
the heart should be attached to the lungs, in this trial.) The 
lungs should then be separated from the heart, and from 
each other, and accurately weighed. They should again be 
placed separately in the water, and the result noticed. If 
one only floats, note which one it is. Each lung should 
then be cut up into about fifteen pieces, and each piece sub- 
mitted to the test. They should next be subjected to suit- 
able compression, by enclosing them within the folds of a 
towel, and pressure applied ; after which they should again 
be put into the water, and the result noted as to whether 
they continue to float or not. 

SECTION II. 

(2) PROOFS OF A LIVE BIRTH DERIVED FROM THE ORGANS OF 
CIRCULATION, AND FROM THE ABDOMINAL ORGANS. — PECULIARI- 
TIES OF THE FCETAL CIRCULATION. — UNCERTAINTY OF THESE 
SIGNS. — DESSICATION OF THE UMBILICAL CORD. — (3) PROOFS OF A 
LIVE BIRTH FROM THE ABDOMINAL ORGANS. — EVIDENCES FROM 
THE STOMACH AND INTESTINES. 

There are a number of striking peculiarities in the circu- 
latory organs of the foetus, which are modified, or entirely 
lost after respiration is established. A knowledge of these 
changes is, therefore, of importance in a case of infanticide. 
The evidence to be derived from the changes in the heart 
and foetal vessels (docimasia circulationis) comprises the 



INFANTICIDE PROOFS OF A LIVE BIRTH. 469 

examination of the foramen ovale, the ductus arteriosus^ the 
ductus venosus, and the umbilical cord. Although, as a 
general rule, the closure of the three first-named openings 
takes place at birth or soon after, yet, in many instances, 
it occupies a considerable time, so that in cases of infanticide 
the test is, practically, of little or no value. 

T'W^ foramen ovale is the opening between the two auricles 
of the foetal heart, through which, before respiration, the 
blood passes directly from the right to the left side of that 
organ. It usually closes at birth, or very soon after ; but 
instances are known where it continues open up to adult 
years, and even throughout life. 

The ductus arteriosus is a vessel about half an inch long, 
which, in the foetus, forms a direct communication from the 
right ventricle to the aorta ; it may, in fact, be regarded as a 
direct continuation of the pulmonary artery to the aorta. 
The effect of this arrangement is, that most of the blood 
from the right side of the heart, instead of being propelled 
to the lungs through the right and left branches of the pul- 
monary artery, is sent directly to the aorta, and thence into 
the general circulation. The branches of the pulmonary 
artery, in the foetal state, are extremely small, inasmuch as 
they are called upon to transmit but little blood. 

As soon as respiration commences, the ductus arteriosus 
begins to contract — at first at its aortic extremity and 
gradually throughout its calibre, until, finally, the whole 
vessel dwindles down to an impervious cord. During this 
same period, the branches of the pulmonary artery increase 
in size, in order to transmit the due supply of blood to the 
lungs, which are now performing their proper function. 
The closure of the ductus arteriosus, although usually a 
proof of a living birth, is by no means uniformly so ; 
neither is its open condition a positive evidence of a dead 



470 MEDICAL JURISPRUDENCE. 

birth, since its closure is gradual, and frequently pro- 
tracted. 

The ductus venosus comes off from the umbilical vein, 
and opens into the vena cava ascendens. It is found in the 
posterior part of the longitudinal fissure of the liver. Its 
closure is apt to occur rather sooner than the other open- 
ings before alluded to, but it is quite uncertain as a sign of 
a live birth. 

The umbilical vessels consist of a vein and two arteries. 
The former conveys the blood aerated in the placenta to the 
foetus, passing in at the umbilicus ; and proceeding onward, 
it divides, one part going into the liver and the other part 
going through the ductus venosus into the ascending vena 
cava, and so carrying purified blood to the right auricle of 
the heart. The two umbilical arteries are continuations of 
the hypogastrics ; they convey the effete blood out of the 
body, through the navel, back again to the placenta, there 
to be renewed. After birth, when the route of the circula- 
tion undergoes such a complete change, these vessels be- 
come closed and obliterated ; but the exact time when the 
closure takes place is hardly more certain than in the case 
of the other foetal channels. 

The desiccation of the U7nbilical cord affords valuable evi- 
dence of a live birth, especially if the child has survived 
several days. It is usually of a bluish, pearly-white color, 
about the thickness of a finger; and within twelve to twenty- 
four hours after birth loses its polish, becoming dry and 
flaccid. It is generally cut and tied about three inches from 
the umbilicus at the time of the birth. The process of 
desiccation commences at the severed end ; in the course of 
twenty-four hours it reaches to within half an inch of the 
navel, this portion still remaining pulpy, and of an amber 
color. About this time the skin of the abdomen around the 



INFANTICIDE PROOFS OF A LIVE BIRTH. 471 

umbilicus becomes red and swollen, and is pushed up around 
it in the shape of an inverted cone. During the second 
and third day, the cord gradually withers and dies, becoming 
flattened and twisted, and suppuration begins on the still 
moist portion attached to the navel. A line of demarcation 
is seen forming; and on the fourth day, the free end of the 
cord becomes of a yellowish-brown or black color, and has 
the appearance of transparent glue. The separation of the 
cord usually occurs on the fourth, fifth and sixth d,iys — the 
majority of cases being on the fifth. Occasionally, the 
separation takes place some days later. 

Although the separation of the cord is a vital act, and can 
occur only in a living child, its dessication may take place 
equally in a dead child, although it occupies a much longer 
time in the latter, sometimes not commencing for several 
days after birth. But the important point of distinction be- 
tween the two is that spontaneous separation of the cord 
never occurs in a dead-born child ; it merely withers and 
dries up, but remains attached. Hence, the dessication and 
separation of the cord, and the subsequent cicatrization, 
afford positive proof that the child was born alive, and had 
continued to live some days after its birth. 

3. Proofs of a live birth derived from the abdominal 
organs : — 

In the foetus, the liver is, relatively, enormously large and 
very vascular, doubtless in consequence of the important 
function it has to perform in connection with the circulation 
of the blood. Meckel found the absolute weight of the 
liver to diminish until the end of the first year of extra- 
uterine life. In five new-born children, the liver was found 
to be one-fourth heavier than in five other children of eight 
to ten months old. It is suggested by Beck, that the loss 
of weight by the liver ought to be supplemented by the gain 



472 MEDICAL JURISPRUDENCE. 

of weight by the lungs, and so be confirmed by Ploucquet's 
test. 

The stomach and intestinal canal may sometimes afford 
positive proofs of a hve birth, from the discovery therein of 
certain matters — hquid and soHd — such as blood, milk, fari- 
naceous and saccharine articles. The two former substances 
may be identified by the microscope, which, however, fails 
to distinguish between human and cow's milk ; but the de- 
tection of colostrum corpuscles in the contents of the child's 
stomach would be good evidence that the milk was from a 
woman very recently delivered. Another test for the pres- 
ence of milk is that of Trommer, for grape (or milk) sugar. 
The suspected substance, properly diluted, is treated with a 
weak solution of cupric sulphate and liquor potassae in excess, 
and then boiled; a red precipitate of the red oxide of copper 
proves the presence of lactine. 

Farinaceous matters may be easily recognized by the ap- 
plication of tincture of iodine, which imparts a deep blue 
color ; and also by microscopic examination, which may even 
identify the particular variety of starch, as arrow root, 
potato starch, etc. 

Sngar should be identified by Trommer's test. A con- 
centrated, aqueous extract of the contents of the stomach 
should be used for this purpose, and the test applied in the 
manner described for detecting milk. 

The presence of blood in the stomach is not, necessarily, 
evidence that the child was born alive, since it is possible 
that it might have been drawn into the throat from the ma- 
ternal discharges, during the passage of the head through 
the outlet, and before it had breathed. 

The presence of meconium in the stomach, like that of 
blood, is not a positive indication of a live birth, because 
the child may have drawn it into the stomach and air 



INFANTICIDE CAUSES OF DEATH. 473 

passages by aspiration, in the passage of the head over this 
substance, through the outlet. Meconium is recognized by 
its dirty, dark-green color, and want of fecal odor. The 
microscope shows it to contain crystals of cholesterine, 
epithelial scales, masses of green coloring matter of bile 
(biliverdine) and granules. 

The absence of meconium from the intestines (where it is 
usually found at birth), and also the absence of urine from 
the bladder, are not, necessarily, evidences that the child has 
been born alive, since these liquids may be discharged during 
the act of birth. 

SECTION III. 
THE CAUSE OF DEATH IN THE NEW-BORN CHILD. 

(l) CAUSES ACTING DURING BIRTH. — COMPRESSION OF AND BY THE 
CORD. — PROTRACTED DELIVERY. — DEBILITY, HEMORRHAGE, FRAC- 
TURING OF SKULL. — (2) CAUSES ACTING AFTER BIRTH. — CONGEN- 
ITAL MALFORMATION AND DISEASE. — EXPOSURE. — IMPROPER FOOD. 
— WOUNDS AND INJURIES. — SUFFOCATION. — STRANGLING. — DROWN- 
ING. — POISONING. — ACCIDENTAL CAUSES. — MODE OF CONDUCTING 
THE EXAMINATION. 

II. Cause of death in the new-born child. — Having dis- 
posed of the Question I — Has the child been born alive? — 
we are now prepared to discuss the second, viz. — What was 
the cause of its death? These causes are various; they 
may be considered under the heads of such as act during 
birth, and such as act subsequently ; also, such as are acci- 
dental, and such as are crhninal. It is the latter only that 
can be connected with a charge of infanticide. 

In an investigation of this character it should be remem- 
bered that a large proportion of children are born into the 
world dead, or still-born, amounting to one in every eighteen 
or twenty of legitimate children. Among illegitimate chil- 
dren the proportion is much greater — probably one in ten 
21* 



474 MEDICAL JURISPRUDENCE. 

(Taylor). As before mentioned, this throws the burden of 
proof of a Hve birth, in a case of infanticide, on the prose- 
cution, as the law assumes in all such cases that the child 
was born dead. 

I. Causes acting during bh'th. — (i) Compression of, and 
by, the umbilical cord. This may happen in breech or foot 
presentations; also when it is prolapsed in these, or in head 
presentations. In such labors, it is well understood that 
unless the cord is speedily relieved of pressure, the child 
will perish. Another cause of compression arises from its 
being wound round the child's neck. This is quite a 
frequent complication, being found as often (according to 
Elsasser) as one in every five cases. In the latter instance, 
death may proceed either from the constriction of the child's 
neck, by the cord causing congestion of the brain, or from 
the interruption of the flow of blood in the cord itself, owing 
to the strain upon it. The effects of the constriction of the 
neck by the cord are not precisely similar to those of stran- 
gulation in a child that has breathed ; and inasmuch as 
children are not unfrequently purposely strangled after the 
head is born, and before the rest of the body is expelled, it 
is important to understand if there are any means of dis- 
tinguishing between the two cases. 

In the last-mentioned case, if the child had not breathed 
when the strangulation was effected, there would be no 
means of distinguishing it from death occasioned by con- 
striction of the cord, except where marks of the ligature 
have been left upon the neck of the child. The question 
then is, does the cord ever leave such a mark upon the 
neck ? We reply that the cases are extremely rare where 
the cord leaves any mark identical with that produced by a 
ligature in actual strangulation. Dr. Elsasser states that out 
of 327 cases of labor in which the navel string was twisted 



INFANTICIDE CAUSES OF DEATH. 475 

around the child's neck, there was one fold of it in 228 
cases ; two folds in 83 cases ; three in 13 cases, and four in 
4 cases. Yet in the whole series, there was not a single 
instance in which the least mark, impression or ecchymosis 
was visible. In some cases the cord was so tightly wound 
around both neck and body that it was necessary to divide 
it before delivery could be accomplished (Wharton and 
Stille, Med. Jurisp.^ vol. II, p. 121). Yet there are some 
undoubted instances, reported by respectable authorities, 
where the umbilical cord has left very positive marks upon 
the neck of the child, sometimes a mere furrow or depres- 
sion, and again distinct lines of a red or blue color, some- 
times single, and at others two or three parallel ones. It is, 
however, extremely doubtful if a true ecchymosis or extra- 
vasation of blood ever results from compression of the neck 
by the navel string ; certainly, there can be no abrasion of 
the cuticle, as is frequently observed in cases of strangula- 
tion by a rough string or cord. Even a livid mark around 
the neck is not necessarily caused by an effusion of blood, 
and such marks will often be found to disappear on the 
establishment of respiration. It should also be remembered 
that, in fat children especially, if the neck be short, and the 
body has been kept in a cold place, furrows and ridges may 
be formed in the folds of the skin, which, to an ordinary 
observer, might be suggestive of strangulation. 

Should a ligature be actually found around the child's 
neck, there could, of course, be no longer any question 
about the impression not being due to the umbilical cord. 
The usual defence in such a case is that the ligature was 
placed there by the woman herself, for the purpose of assist- 
ing her delivery, and no medical evidence can disprove such 
a statement. If the strangulation has been accomplished 
by the hand, the impression left will usually be very distinct 



476 MEDICAL JURISPRUDENCE. 

and suggestive, and totally different from those produced by 
the navel string, which, at most, leaves a broad, smooth 
indenture, with soft edges. 

The cord sometimes, by being coiled around the limbs 
and body of the child, before birth, produces deep depres- 
sions in the skin. Even an amputation of a limb has been 
observed as an effect (Virchow's Archiv., X, no). 

(2) Protracted delivery is not unfrequently the cause of the 
child's death, especially in first labors. It may be ascribed 
either to congestion of the brain, resulting from the com- 
pression of the head, or to interruption to the circulation in 
the umbilical cord, through pressure, before respiration can 
be performed. In primiparous cases, the labor is very apt 
to be protracted, and the child large, often requiring the 
application of the forceps. In death from this cause, the 
head will usually be found much elongated, with evidences 
of considerable pressure, and having a large caput succeda- 
neum. The autopsy will disclose congestion of the cerebral 
vessels. 

(3) Debility. — A child may be born either prematurely, or 
at full term, and soon die from constitutional weakness, 
either inherited or produced by causes acting upon it in 
lUero. In such feeble children a very slight cause is suffi- 
cient to destroy life. Such cases are recognized by the 
immature condition of the body, and the absence of all other 
causes of death. 

(4) Hemorrhage from the cord is sometimes the cause of 
death in the new-born child, either from accidental rupture 
during the birth, or after its severance. The sudden prema- 
ture separation of the placenta will produce the same result. 
The child, under these circumstances, will exhibit a blanched 
and waxy appearance, together with a paleness and dryness 
of the internal organs, particularly of the heart and lungs. 



INFANTICIDE CAUSES OF DEATH. 477 

This will not, however, hold good where putrefaction of the 
body is advanced. The hemorrhage may be accidental, or 
the result of criminal design. In either case it may have 
arisen from laceration of the cord, or from an omission to 
tie it after birth. The question of the propriety of tying 
the cord at birth need not be discussed here. It appears to 
be the fashion with some modern accoucheurs to omit this 
act, as unnecessary; but we unhesitatingly give our adher- 
ence to the old custom. It has occurred to the author to 
witness one case of fatal hemorrhage of the cord some days 
after birth, in spite of every effort to control it. Casper, 
with his large experience, states that he never met with a 
fatal case of hemorrhage of the cord, although he had wit- 
nessed several where it had been cut off close to the navel 
(Op. cit. I, 864). 

It would appear, from numerous cases reported, that fatal 
hemorrhage is less apt to follow when the cord is ruptured 
than when it is cut, probably for the same reason that a 
torn artery is less likely to bleed than one severed with a 
knife. According to Wharton and Stille {^Med. Jurisp., II, 
p. 125), it is the habit of the Indian squaws to break the 
cord, and then bind the foetal end with a strip of bark. 
Numerous instances are also mentioned of rapid delivery in 
women in an upright position, where the child has suddenly 
escaped from the mother, and fallen to the ground, rupturing 
the navel string, yet without any bleeding of consequence. 
We know that the instinct of some animals leads them to 
divide the cord with their teeth, whilst in others, it is rup- 
tured either by the fall of the young while the mother is 
standing upright, or else by her suddenly springing up when 
delivered, in a recumbent position. This is the case with 
the horse and cow. 

The usual length of the umbilical cord is from eighteen 



478 MEDICAL JURISPRUDENCE. 

to twenty inches ; but it frequently exceeds this ; in one 
instance, reported by Dr. Tyler Smith, amounting to fifty- 
nine inches, and in another, reported in the Boston Med. 
and Stir g. Journal, July, 1850, to sixty-nine inches. In ordi- 
nary cases of delivery in the upright posture, the child may 
fall a distance of twenty- eight to thirty inches to the ground, 
without putting a strain upon the cord. But, in most 
instances of this nature, this distance would be diminished 
by the woman instinctively assuming more or less of a bend- 
ing position at the moment of expulsion. Still, it might 
happen that the cord might be unusually short, or else 
wound round the child, in which case it could easily be 
ruptured. The point at which the rupture usually occurs 
is a few inches from the umbilicus. In some instances of 
sudden traction, where it does not break, the placenta 
attached may be dragged out by the weight of the child. 

(5) Fractures. — These are chiefly confined to the head of 
the child, and may be produced during any period of ges- 
tation, either accidentally or otherwise, from blows, falls, or 
other injuries, such as the kick of a horse, etc. Other bones 
may, of course, be fractured by blows, or injuries sus- 
tained by the mother during intra-uterine life; and in some 
instances, where the result is not fatal to the child, the 
marks of bony union are visible at its birth. In most cases 
of such a character, however, the child perishes at the time, 
and is born prematurely, so that the question of infanticide 
would hardly present itself. 

But fractures of the skull may occur accidentally during 
labor, arising from a disproportionate size of the child's 
head, or some deformity or osseous tumor of the mother's 
pelvis. As such cases usually require instrumental aid, the 
injury may have been unavoidably caused by the forceps. 
Such fractures, however, are very rare, on account of the 



INFANTICIDE CAUSES OF DEATH. 479 

extreme mobility of the cranial bones upon each other, 
which allows of considerable pressure, and reduction of the 
volume of the head. In these cases, as the child may sur- 
vive sufficiently long to breathe, it is of importance to prove 
that the fracture was accidental, and not criminal. In the 
former case, the fracture is nearly always on the parietal 
bones, sometimes in the frontal, but never in the occipital 
bone. It is usually a mere fissure or crack, very rarely a 
depression, unless great violence had been employed. In 
cases of criminal violence, the fracture would probably be 
stellated or depressed, the bones often being driven deeply in, 
and the brain even protruding, together with laceration of the 
scalp, and other marks of violence. But, in a case where 
the criminal fracture happened to be only slight, it might be 
impossible to distinguish it from one resulting accidentally 
at the birth. It should also be remembered that very ex- 
tensive fractures of the child's skull may result from criminal 
violence, without any visible trace of injury to the scalp. 
There is also a possibility of mistaking a defective ossifica- 
tion of the bones of the cranium for fracture. This defect 
occurs usually in the parietal bones, and is caused by a 
deficiency in the bony spiculae, which is replaced by a mem- 
brane that fills up the gap. The edges of the bones are 
thin and beveled, and show no marks of injury. A true 
fracture is evidenced by a red line, seen on removing the 
pericranium, by the edges of the bone being jagged and 
bloody, and by the absence of any membrane ; there is also 
more or less effusion of blood in the neighborhood of a 
fracture. 

But the cases that occasion the greatest difficulty to the 
legal physician are those in which the fracture is alleged to 
have resulted from the fall of the child from the maternal 
parts to the ground, in consequence of a sudden delivery 



480 MEDICAL JURISPRUDENCE. 

while in the erect position. Such cases, although compara- 
tively rare, occur sufficiently often to require attention. 
They present no special marks by which they can be dis- 
tinguished from cases of criminal violence. Some writers 
even deny the possibility of this accident, but the great 
weight of authorities, including Casper, admit their occa- 
sional occurrence. In order to test the matter, the last- 
named author made experiments on the bodies of twenty- 
five dead infants, letting them fall from a height of thirty 
inches upon a hard pavement. One parietal bone was found 
fractured in sixteen cases ; both parietals in six cases ; once 
the parietal and frontal ; once the frontals ; and once the 
occipital. The fractures, in most cases, occurred about the 
parietal protuberances. It should be remembered that it is 
easier to fracture the skull of a live infant than that of a 
dead one. So, also, it has been ascertained that when firm 
pressure by the thumbs and fingers is made upon the head 
of a new-born dead child, out of fifteen experiments, in seven, 
long fractures of one or other parietal bones resulted ; in 
the other cases, the result was merely a depression of the 
bone. Hence, we must conclude that the possibility of such 
an accident should always be taken into consideration, in 
cases of concealed birth, when fractures of the skull are 
discovered. 

2. Causes of death after birth. — These are both numerous 
and varied, (i) Congenital malformation and disease may 
exist ; but in most cases, life may endure, though for a brief 
period, even in monstrosities. Some of these malformations 
are remediable, others are not. If violence should be in- 
flicted upon such beings for the purpose of destroying life, 
the evidences for its discovery are similar to those employed 
in other cases. 

(2) Exposure. — Under this head may be included all the 



INFANTICIDE CAUSES OF DEATH. 481 

different cases of abandonment of the new-born child. As 
is well known, the new-born infant speedily perishes if not 
properly cared for in the way of food and clothing. Authori- 
ties generally agree that deprivation of nourishment for over 
twenty-four hours is likely to prove fatal. Fodere states 
the greatest length of time to be one or two days. Yet, 
there are cases on record where the infant survived tJiree 
days without any food, and exposed, at the same time, to 
the variations of the temperature. 

The proofs of death from exposure to cold are by no 
means positive, unless the body be discovered frozen stiff, 
discolored and shriveled, naked, or scantily covered, in a 
cold place, buried under stones or earth, its lungs affording 
evidence of previous respiration, the internal vessels gorged 
with blood, while the external ones are empty, the brain 
deeply congested, as also the lungs and right heart (Fodere). 
Under such circumstances, and in the absence of all causes 
of death, it may be ascribed to cold. 

The signs of death from starvation are to be sought for 
in the same general way. These are an emaciated and 
shriveled body ; a pale and wrinkled countenance, expres- 
sive of pain; dry, tough and yellowish skin; the mouth, 
tongue and fauces also dry; the stomach and intestines 
empty and contracted ; gall bladder enlarged, and bile 
usually found in the alimentary canal ; stomach inflamed 
in points; the heart flaccid, and the great vessels almost 
empty. Cases of infanticide by starvation are rare. In 
order to establish the charge, it must be shown that the 
woman willfully kept the child without food, and with a 
criminal design. Mere neglect or imprudence is not suffi- 
cient. In a suspected case of this kind, it is recommended 
to examine the contents of the stomach for starch, and other 
varieties of food. 



482 MEDICAL JURISPRUDENCE. 

There is no doubt that many young children are pur- 
posely exposed to the danger of starvation, by putting them 
out to be nursed on impi^oper^ as well as scanty food, as 
witnessed in the wretched system of baby-farming. 

(3) Wounds and Injuries. — These are frequently the cause 
of death in new-born children ; they usually prove rapidly 
fatal, and, as a rule, leave no signs of inflammation, or its 
results, to indicate that the wound was made during life. 
The best evidence of the ante-mortem character of the 
wound is the presence of a coagula under, and around it. 
These indicate that the circulation was going on at the 
time ; but, if the effused blood be liquid, the presumption 
is that the injuries were inflicted after death, and while the 
body was yet warm. An accidental wound upon the child 
(usually on the arm or leg) might be made by the knife or 
scissors employed in cutting the cord ; but in such a case, 
there should be proof that the cord had been really cut^ and 
not ruptured. 

Pejietrating and punctured wounds, of apparently trifling 
character, may easily prove fatal to a new-born child. Thus, 
punctures made by a needle or stillette into the fontanelles, 
between the vertebrae, or under the orbit, are almost sure to 
destroy life. Beck mentions the case of a midwife who was 
executed in Paris for killing several children by plunging a 
needle into the head, as it presented itself at the mouth of the 
womb. He also cites the case reported by Dr. Underwood, 
of a lady's child, who died in convulsions, which could not 
be traced to any cause until after death, when a pin, that had 
accidentally gotten under the child's cap, was found inserted 
into the fontanelle(J^'</.y2^m^., vol. I, p. 552). The cause of 
death in such cases may easily escape detection. If suspected, 
the skin should be carefully dissected off and spread out before 
the light, when the finest puncture can be detected. 



INFANTICIDE CAUSES OF DEATH. 



483 



Dislocation and fracture of the neck (twisting of the neck) 
are occasional causes of death in new-born children; Of 
course, in such cases, the defence would ascribe it to acci- 
dent in the efforts to disengage the child from the mother, 
and the fact of criminal interference could only be estab- 
lished by the attending circumstances. It should also be 
remembered that cases are recorded where other disloca- 
tions, as of the hip and knee, have taken place before birth, 
as the results of an injury to the mother. 

(4) Asphyxia, in its various forms, is the most common 
of all the means of destroying the new-born child. Ac- 
cording to M. Tardieu, whose ample experience extended 
over twenty-four yQ.2.x?>,four-fiftJis of all the cases of infanti- 
cide that he had examined were due to some form of as- 
phyxia. His 555 cases are thus tabulated : — 



Suffocation, . 

Immersion in privies, 

Strangulation, 

Drowning, 

Fracture of skull, 

Burns, 

Neglect, 

Wounds, . 

Hemorrhage of navel. 

Exposure to cold, 

Poisoning, 



Total. 



281 ■] 
72 ! (Asphyxia] 
60 I 444 

31 J 
70 
8 

14 
8 
6 

3 

2 

555 



Asphyxia may be effected in various ways — as by suffo- 
cation, strangling, hanging and drowning, by smothering 
under the bed clothes, by exposure to noxious vapors or 
gases, and by thrusting various substances into the mouth 
and nose. 

(a) Suffocation. — This is a frequent cause of accidental 



481 MEDICAL JURISPRUDENCE. 

death in new-born children, arising from neglect to remove 
it from the maternal discharges, or from the bed clothes, 
or from disengaging its face from the membranes or caid, 
which is sometimes spread over it, or removing the mucus 
from its mouth and throat. In some cases, the obstruction 
is caused by meconium, blood or faeces, which have been 
taken in by aspiration, in the passage of the head through 
the outlet, or immediately after birth. Such instances of 
accidental suffocation usually occur where the woman was 
delivered alone, and without any assistance. 

Suffocation is a very frequent criminal cause of death in 
cases of infanticide. The facility with which it can be ac- 
complished, the slight risk of detection, in consequence of 
the difficulty of distinguishing it from an accident, doubtless 
cause it to be so often resorted to. A wet cloth simply 
placed over the mouth, or thrust into that cavity, either be- 
fore or after respiration, and pressure on the child's chest 
(though the latter might accidentally occur at birth, when 
the head is born, and the body is retained for some time 
and subjected to pressure in the outlet), foreign bodies in- 
troduced into the mouth and throat, such as tow, hay, 
feathers, ashes, etc. — such are the means commonly em- 
ployed for suffocating the child. In one case, a mass of 
dough had been forced down the throat, so as to obstruct 
the larynx; in another, the back part of the throat was 
packed with wet sand ; and in a third, the respiratory pas- 
sages were filled with cinders, drawn in suddenly by aspi- 
ration. A child may also be suffocated under the bed 
clothes, or by exposure to the noxious vapors of sulphur, 
burning charcoal, the exhalations of privies, etc., and with- 
out leaving any trace of the real cause of death. 

Strictly speaking, the child cannot be said to be siijfocatcd 
unless it has first breathed ; yet in many cases the death is 



INFANTICIDE CAUSES OF DEATH. 485 

brought about before respiration is established — breathing 
is simply prevented. Under such circumstances, it would be 
impossible for the examiner to ascribe the death to a crim- 
inal act, unless there existed very evident marks of undue 
violence. In every case of infantile suffocation, a careful 
inspection of the respiratory openings should be made, in 
order to detect the presence of foreign bodies. In true cases 
of suffocation the post-mortem signs are those of apnoea gen- 
erally — such as congestion of the right heart and venous 
system, and also of the brain ; but there are present, also, 
the punctiform ecchymoses under the pleura, pericardium, 
endocardium, peritoneum and bronchi, so much insisted on 
by M. Tardieu. The lungs of infants, according to the best 
authorities, are not usually found engorged with blood. Dr. 
Tidy says, " if the child be vigorous and well-developed, 
the muscular and elastic forces of the arteries and arterioles 
will be sufficient to drive the blood on, after the heart has 
ceased to beat, and respiration is prevented. Such lungs 
will, therefore, be found comparatively bloodless or anaemic, 
but with a large amount of emphysema, or dilatation and 
rupture of the air-cells, owing to the violent attempts at in- 
spiration or breathing " ( Woodm. and Tidy's Foren. Med.y 
p. 695). 

If the death has resulted from pressure of the body under 
the bed clothes, the head will be found flattened, the tongue 
protruding, the eyes half open, a frothy mucus escaping 
from the corners of the mouth, and the excrements voided. 

(b) Strajzgidation. — A not unfrequent mode of child- 
murder. The marks of this differ according to the different 
methods employed. Since, in criminal strangulation, much 
more violence is usually employed than is necessary, the 
neck will be very apt to bear the impress of the fingers, or 
of the ligature employed, and sometimes of both. At times 



486 MEDICAL JURISPRUDENCE. 

there may be abrasion of the cuticle from the roughness of 
the hgature, and also ecchymosis surrounding the marks of 
the latter. 

In all such cases of infanticide, the usual defence set up is 
that the cord was placed upon the neck of the child to aid in its 
delivery; or else it will be attributed to the accidental encir- 
cling of the navel string ; this, however, would be disproved 
by the fact of breathing (vid. ante, p. 474). Even the marks 
of the fingers upon the throat, indicating throttling, w\\\ be at- 
tempted to be explained by referring them to the same cause. 

The question whether the marks of the cord in strangu- 
lation can be imitated if it is applied after death, must be 
answered in the affirmative, provided it is done very soon 
after death, and while the body is yet warm {vid. ante, p. 148). 

The only difference between strangling and hanging, as a 
mode of child-murder, is the oblique mark of the cord about 
the neck in the latter. Hanging is certainly a very rare 
form of infanticide. 

(c) Drowning. — There are no signs to indicate death 
from drowning in the body of a child that has not breathed ; 
yet this form of infanticide has been known to be perpetrated 
criminally, as when a woman causes herself to be delivered 
in a bath, so as to retain the child under water and thus 
prevent its breathing. After respiration, the signs of drown- 
ing are the same as in adults {vid. p. 159). Here, the im- 
portant medico-legal question is. Was the child alive, or dead 
when thrown into the water ? Generally, it is the latter ; 
hence the importance of an accurate inspection of the body 
to ascertain the existence of marks of violence, some of 
which would be positive evidence of antecedent death, 
whilst others might possibly be ascribed to accidental causes. 
In all such cases, the throat and air passages should be 
especially investigated for foreign substances. 



INFANTICIDE CAUSES OF DEATH. 487 

It should be remembered that a young infant may easily 
be drowned by the simple immersion of the face in water. 
Cases have occurred where, through unconsciousness, or in 
a very rapid delivery, the child is projected into a commode 
half full of water, where it would certainly perish by drown- 
ing if not soon rescued. A case of this nature once 
occurred in the practice of the author, which, however, did 
not result fatally. The same thing may happen to a woman 
mistaking the sensation caused by the pressure of the 
child's head on the perineum for the feeling of a desire to 
evacuate the bowels. Yielding to this impulse, and sitting 
upon the opening of a privy, a sudden pain will eject the 
child from the maternal parts, and in its fall the umbilical 
cord will be ruptured, or else (in rare cases) the placenta 
may be dragged out still attached, and the child will miser- 
ably perish in the semi-liquid filth in which it lies. Cases 
of this sort are not of very unfrequent occurrence, and it is 
extremely difficult, if not impossible, for the medical jurist 
to distinguish these from cases of criminal infanticide of a 
similar nature, since they will both exhibit the same evi- 
dences of death from suffocation. In a criminal case, how- 
ever, the accompanying circumstances may sometimes lead 
to the detection of the culprit, as when marks of blood are 
discovered in her bedroom, which may, perhaps, be traced 
to the privy ; or where the umbilical cord may be discovered 
cut, and not ruptured ; or where other circumstances might 
present which would render the prisoner's account incon- 
sistent with the theory of accident. 

(5) Poisoning is an extremely rare form of infanticide, 
although it is a frequent mode of destroying young chil- 
dren. One case is recorded of poisoning a child one day 
old with arsenic, where the woman was acquitted, upon the 
plea of puerperal insanity {Ed. Month. Jour., Sept. 1852). 



488 MEDICAL JURISPRUDENCE. 

The following general conclusions may be considered as 
warranted from the foregoing considerations: i. Did the 
death occur naturally ? 2. Could it have been prevented ? 
3. Is the mother guilty of not having used proper precau- 
tion ? 4. Was the death caused by violence on the part of 
the mother? 5. If there are marks of violence upon the 
child, did the mother inflict them ? 

From what has been said upon this subject, it is evident 
that medical testimony is not always sufficient of itself to 
establish a charge of infanticide. So many cases, as we have 
seen, occur in which precisely the same medical signs are 
exibited in both accidental and criminal death in new-born 
children, that the attending circumstances have to be de- 
pended upon in order to come to a decision. It becomes, 
therefore, the serious duty of the legal physician, in a case 
of infanticide, to make the very fullest investigation, includ- 
ing, of course, the most thorough autopsy of the body. 
To this end, a few practical suggestions are here added. 

MODE OF CONDUCTING THE EXAMINATION IN A CASE OF 
INFANTICIDE. 

(i) External. — A careful external inspection of the body 
of the child is first to be made. Note the color, sex, length 
(measured from vertex to feet), the presence or absence of 
putrefactiofi, wounds, bruises, injuries, stains, etc. Take the 
dimensions of the thorax, shoulders and head; also ascertain 
the weight of the body, and the centre of the body, and note 
the condition of the umbilical cord. 

(2) Internal. — Observe the shape and condition of the 
thorax; the lungs, as to their position, volume, shape and 
color ; their absolute and specific weight ; the position of 
the diaphragm ; the condition of the heart as to tho. foramen 
ovale, and ductus arteriosus ; also the ductus venosus, and the 



INFANTICIDE THE AUTOPSY. 489 

umbilical vessels. In the abdomen observe the stomach and 
intestines, the liver and bladder. Also notice the brain and 
spinal marrozv. 

The autopsy. — The first incision should be made com- 
mencing at the centre of the lower jaw, and extend down to 
the lower end of the sternum. Some advise to divide the 
lower jaw at the symphysis, so as the more completely to 
expose the buccal cavity in the search for foreign substances ; 
this, however, may not be necessary. The position and ap- 
pearance of the tongue are to be specially noticed. The 
larynx and trachea are next to be laid open, and as much of 
the oesophagus as can be now seen. The incision is now to 
be carried down on each side of the spine of the ilia, and 
the triangular portion of the integuments thus shaped out 
is to be turned back, so as to examine the condition of the 
umbilical vessels. The abdomen is next to be opened, and 
the position of the ^/^/Ar^^//2 noticed. All the viscera are 
to be carefully inspected, together with the ductus venosuSy 
behind the liver. The stomach and bowels are to be tied 
and removed, in order to search for poison. If suspected. 
The gall bladder and urinary bladder should be examined ; 
also the presence or absence of meconium in the large 
intestines be ascertained. 

The thorax should be opened by the scissors, preferably 
to the knife, at the junction of the costal cartilages. After 
examining the general appearance of the contents, all the 
great vessels are to be tied, and divided beyond the liga- 
tures ; the trachea is also to be divided at its root. The 
lungs are then to be taken out and weighed, and subjected 
to the hydrostatic test. The heart may now be examined 
as to the condition of the foramen ovale, and ductus arterio- 
sus. The head may be examined by making one incision 
from the root of the nose back to the neck, and another at 

22 



490 MEDICAL JURISPRUDENCE. 

right angles from ear to ear ; a strong scissors should be 
used in cutting through the bones. The brain is to be 
inspected in the usual manner. The spine may also require 
examination, as also the vertebrse. 

The other two questions pertaining to the infant, in a case 
of child-murder, have reference to its age, and the interval 
elapsed since its death. The age of the new-born child is to 
be determined by ascertaining if it exhibited the recognized 
character of a fully matured foetus {vid. ante, p. 447). The 
exact interval of time that has elapsed since its death cannot 
be determined merely by a medical inspection. Many cir- 
cumstances would have to be considered, such as the season 
of the year, the temperature, the place where the body was 
discovered, etc., before the examiner could venture an 
opinion; and he should always be extremely cautious in the 
matter, seeing how uncertain are the signs on which that 
opinion is to be founded. 

SECTION IV. 

II. QUESTIONS RELATING TO THE MOTHER IN A CASE OF INFANTI- 
CIDE — SIGNS OF DELIVERY. — SIGNS AFFORDED BY AN EARLY 
EXAMINATION OF THE WOMAN. — EXAMINATION OF THE MILK. — 
CONCEALED DELIVERY. — CONCEALMENT OF BIRTH. — PRETENDED 
DELIVERY. 

It is necessary in every case of alleged infanticide to con- 
nect the condition of the reputed mother with that of the 
infant, so as to establish the fact that she has been actually 
delivered about the time when it is judged that the child 
was born. This is always sufficiently easy, provided the 
case is a recent one, and the mother can be found, and is 
willing to submit to medical examination. But it is alto- 
gether different where a considerable interval has elapsed 
since the birth, and where the woman has either disap- 



DELIVERY SIGNS AFFORDED BY THE MOTHER. 491 

peared, or has so completely recovered from the effects of 
her confinement as no longer to offer any signs by which it 
can be proven. 

The question then, is — Has this woman been recently 
delivered ? To give a satisfactory reply, she must be 
properly examined. If the examination is made within 
three or four days after delivery, the following signs will 
usually be exhibited : there is more or less weakness, some 
pallor of face ; the eyes a little sunken, with a dark areola 
under or around them; the skin is soft, moist and relaxed ; 
the whole aspect resembling that of a person recovering 
from sickness. The pulse is soft and a little quickened; 
the abdomen feels soft and relaxed to the touch, and 
is sometimes thrown into folds, and presents on the surface 
a number of transverse, livid lines, which, at a later period, 
become white and shining, or silvery (linece albicantes). 
The uterus can be distinctly felt through the wall of the 
abdomen, low down, like a large ball. The breasts have 
a full and somewhat knotted feel ; they are generally 
enlarged, and the nipples are prominent, and often exude 
a watery milk. 

The external organs of generation are swollen, relaxed 
and moist; the vagina capacious, and without folds; the os 
uteri easily felt to be low, and somewhat patulous ; the lips 
soft and relaxed, and, perhaps, slightly lacerated. The 
uterine sound will show the increased depth of the uterine 
cavity, and prove the tumor felt from the outside to be the 
womb. There will be a dark muco-sanguinolent discharge 
from the uterus, known as the lochia, readily distinguishable 
by its peculiar odor. The color of the lochia subsequently 
becomes much lighter, or greenish; this discharge usually 
disappears in a week or ten days, and in some instances, it 
is suppressed. 



492 MEDICAL JURISPRUDENCE. 

These signs combined form a very positive proof of de- 
livery, although no one of them singly can be relied upon. 
The condition of the genital organs affords, on the whole, 
the most conclusive evidence. 

The linece albicantes may result from any distention of the 
abdomen, as ascites, uterine tumor, etc. ; they have even 
been seen in the male. The secretion of milk may be 
absent, and again, it may occur in the unimpregnated con- 
dition ; but the presence of colostrum among the milk cor- 
puscles (to be determined by the microscope) may be 
regarded as conclusive evidence of a recent delivery. The 
lochia and the relaxed state of the genital organs might be 
mistaken for the catamenia, except for the peculiar odor ; 
but the jagged or notched condition of the os uteri, and its 
patulous state are usually to be attributed to a recent 
delivery. 

All the above signs of delivery fail completely after the 
lapse of five to ten days, except the still increased size of 
the uterus, and its rather open and jagged os, together with 
the silvery lines across the abdomen. The two last men- 
tioned signs would be positive evidence, provided it could be 
shown to have been the woman's first pregnancy, and pro- 
vided also the absence of any other abdominal swelling 
could be proved. Otherwise, they only afford grounds for 
suspecting one or more former deliveries. 

Signs of delivery in the dead. — Supposing the woman to 
have died immediately after her delivery, the evidences of 
that fact will be sufficiently manifest. Besides the condi- 
tion of the external organs above described in the case of 
the living, on opening the abdomen, the uterus will be 
found flat and flaccid, between nine and twelve inches long, 
and with the os wide open. The cavity will contain bloody 
coagula, with the remains of the decidua lining the inner 



CONCEALED AND PRETENDED DELIVERY. 493 

surface. The attachment of the placenta will be marked by 
a gangrenous-looking spot. If the death has been delayed 
only a few days, the womb will be considerably contracted, 
and all the above signs will be considerably modified ; and if 
three or four weeks have elapsed, it will be as difficult to 
determine delivery in the dead, as in the living. 

The fact of unconscious delivery must undoubtedly be ad- 
mitted, as it is supported by positive evidence, and as it is in 
accord with the well known instances of a similar character 
in women when in coma, epilepsy, asphyxia, narcotism, and 
anaesthesia from ether and chloroform, and also when in 
profound natural sleep. 

Concealed delivery. — In nearly every case of infanticide, it 
is the object of the woman both to conceal the body of her 
child, and hide all traces of her delivery. The concealment 
of pregnancy is no offence, in law, but the concealment of 
delivery or of the birth of a child is a misdemeanor. As a 
matter of fact and practice, however, women who are tried 
on this charge are punished, not for concealment of the birth, 
but for concealment of the body of the child, — a distinction 
which excites hope in the criminal, that if she can do away 
with the body, she may be free of the law. According to 
the statute, the child must be dead ; the concealment of a 
living body is no offence, unless it should happen to die 
before the birth was made known. In a trial for concealment 
of birth, the medical evidence is derived exclusively from 
the mother ; the body of the child need not be produced, 
and the special points which will engage his attention are 
(i) the proofs of recent delivery ; (2) the proofs of previous 
pregnancy, and (3) the connection between the alleged 
period of delivery and the state of the child as found. ' 

Pretended delivery. — This has occasionally occurred with 
women for the purpose of extorting charity, compelling 



494 MEDICAL JURISPRUDENCE. 

marriage, or disinheriting parties who have claims to an 
estate, and sometimes without any assignable motive. A 
proper medical examination would certainly detect the im- 
posture, because the assumed delivery must be recent and 
not remote. It may occur where the woman has never been 
pregnant, where she had previously been pregnant, and 
where she had actually been delivered, but had substituted 
a living for a dead child. 

Evidences of the death of the child before its birth. — The 
question whether the child is dead in utero may require to 
be determined in certain civil cases involving succession to 
aa estate, contingent to the life of the child; also in criminal 
cases, as where a pregnant woman has been maltreated, and 
her unborn offspring is alleged to be dead. During preg- 
nancy, the life of the foetus is inferred from the general good 
health of the mother, although this is by no means a posi- 
tive sign. The progressive increase in the size of the 
abdomen, together with the continuance of the foetal move- 
ments, though strongly suggestive of foetal life, are not ab- 
solute proofs. The only unequivocal sign is the sound of 
the foetal heart repeatedly heard by auscultation. 

The indications of the death of the foetus during preg- 
nancy are the cessation of all motion, after this has been 
positively felt by the woman. She experiences a sensation of 
a dead weight in the abdomen, along with a sense of lassi- 
tude ; the breasts are apt to recede, or become less promi- 
nent ; there is pallor of the countenance, with a dark circle 
around the eyes ; the spirits flag, amounting at times to 
melancholy ; the breath is fetid. Whilst these signs combined 
may excite a strong suspicion of the death of the embryo, the 
only positive and unequivocal proof of it would be the ascer- 
tained continuous absence of the beat of the foetal heart, by 
means of the stethoscope. It is stated, on good authorities, 



DELIVERY SIGNS OF CHILD's DEATH. 495 

that the placental bruit may continue some time after the 
death of the foetus. 

During actual delivery, the signs of the child's life are 
limpidity of the waters, regularity of the pains, together 
with increase in their strength, pulsation of the cord, and 
also of the heart and fontanelles of the child. 

Putrefaction of the foetus generally occurs soon after Its 
death in utero, and it is usually prematurely expelled within 
a few weeks ; but occasionally it is retained until the full 
term, and may even then not exhibit the marks of decom- 
position. The various causes that may occasion the intra- 
uterine death of the child have already been described 
{ante^ p. 442). 

The indications of the child's death during delivery are 
fetid discharges instead of limpid waters, absence of all 
motion, a livid appearance of the skin, no pulsation of the 
umbilical cord, the cuticle peeling off the head in flakes, 
and the bones of the cranium loose and floating. The 
lividlty of the skin Is not an invariable sign; a case is 
mentioned where, in an arm presentation, the member was 
so livid and cold as to be supposed certainly to indicate the 
child's death ; it was consequently amputated, in order to 
facilitate the labor ; but, to the discomfiture of the accoucheur, 
the child was born alive and survived. 

The general appearance of a foetus that has been dead 
some time before its birth has already been described 
(ante^ p. 458). 



496 MEDICAL JURISPRUDENCE. 



CHAPTER XXXVI. 

LEGITIMACY.— INHERITANCE. 

SECTION I. 

MEDICO- LEGAL IMPORTANCE. — ORDINARY TERM OF HUMAN GESTA- 
TION. — PROTRACTED GESTATION. — ARGUMENT FROM ANALOGY OF 
THE LOWER ANIMALS. — PREMATURE DELIVERY. — EARLY VIABILITY 
OF THE CHILD. — LIVE BIRTH IN CIVIL CASES. 

The question of Legitimacy is one involving the nearest 
and dearest interests of social life, and it is one which, at 
times, is surrounded with no slight difficulties in the attempt 
to solve it, arising from the uncertainty of most of the 
evidence usually advanced to support it. 

Cases involving the question of legitimacy are rarely 
decided upon medical evidence alone; there are usually 
circumstances which point pretty clearly to the fact that the 
child, whose legitimacy is disputed, is the offspring of 
adultery. With these circumstances, however, the medical 
jurist is not concerned. The two important medico-legal 
points for his consideration relate to the questions of pro- 
tracted human gestation, and of pre^nature delivery. 

The following positions may be considered as settled by 
the laws of this country, and also of England : — 

I. Every child born in wedlock is presumed to be legiti- 
mate, unless it can be shown (i) that the parties had been 
separated within the usually allotted period of gestation ; 
(2) the absolute impotence of the husband during this same 
period; (3) the proof of adultery on the part of the wife, and 
the repudiation of the alleged child by the husband ; 
(4) when the woman was so far advanced in pregnancy at 



LEGITIMACY PROTRACTED GESTATION. 497 

the time of her marriage, that her situation must have been 
known to her husband, this will be deemed as a recognition 
of paternity, and also of legitimacy, on his part. 

A child born after the death of its mother (as by the 
Caesarean section) is held to be legitimate, although, strictly 
speaking, the marriage tie is dissolved by her death ; hence, 
as remarked by Dr. Taylor, a child may be conceived before 
marriage, and born after the death of the mother, and yet be 
legitimate, although neither conceived nor born in wedlock. 

L The first medico-legal question has reference to pro- 
tracted gestatio^i^ and this necessarily involves the question 
of the ordinary period of human gestation. The usual 
popular notion upon this point is that it comprises nine 
calendar months (273 to 275 days), or ten lunar months 
(280 days). Ten lunar months was the period allotted by 
the Roman law, which was also the opinion of Harvey, 
dating from the commencement of the last menstrual 
period. There seems to be a fair physiological presumption 
for this latter view, based on the idea that parturition occurs 
at the period of what would be the tenth menstrual effort 
since the last. 

One cause of the discordance existing on this subject 
arises from want of a fixed starting point. This is ordinarily 
referred by women (i), to certain peculiar sensations sup- 
posed to be experienced at conception ; this is altogether 
fallacious, as it is well known that conception may occur in 
the unconscious state; (2) to the period of quickening \ this 
is equally uncertain, since the time of quickening varies so 
much in different women, — from the twelfth to the twenty-fifth 
week, and in some it does not occur at all; whilst in others 
it may be supposed to exist even in the absence of pregnancy. 
(3) Cessation of the catainenia. — This is the usual and, on 
the whole, the surest method of calculating ; but it is liable 
22* 



498 MEDICAL JURISPRUDENCE. 

to many fallacies, such as [a) the arrest of the menses before 
pregnancy ; {b) their continuance for a month or more after 
pregnancy ; {c) again, the intervals between the periods are 
not the same in all women ; usually there is an interval of 
twenty-eight days from the commencement of one period 
to the commencement of another, but it is frequently longer 
or shorter, and this in the same woman at different times. 
As conception may take place at any period of the interval 
between the catamenia, it is evident there might be a differ- 
ence of twenty-three to twenty-five days as to its actual 
date, according as it occurred immediately after the one 
catamenial, or immediately before the succeeding period. 
The usual custom among married women is to reckon nine 
calendar months from the last mentioned period, and to add 
about fourteen days for possible error. There is a remark- 
able diversity of opinion among accoucheurs of the highest 
reputation on the subject of the natural period of gestation — 
varying from 274 to 301 days. It may be assumed that the 
average period is between the thirty-eighth and fortieth 
weeks. 

The most certain and positive starting point from which 
to fix the date of conception is a single intercourse. But 
even where this can be accurately settled, still there will be 
found considerable discrepancies which must be attributed 
to individual peculiarities, and which indicate that there is 
no absolute law on the subject. Observations show results 
varying from 233, 249 and 260 days, up to 293 and 313 
days. Now, even rejecting the two extreme cases of 233 and 
313 days (though they are perfectly authenticated), as very 
exceptional, we still have the great variation of forty-four 
days between the two extremes of 249 and 293 days, or of 
sixty days between the extremes of 233 and 293 days. 
Taking the average of fifty-six cases, dating from a single 



LEGITIMACY PROTRACTED GESTATION. 499 

coitus, reported by various authors, ranging between 260 
and 296 days, it will be found to be 276 days. 

The irregularity as regards the normal period of gestation 
in the human female, finds its analogy among the lower 
animals. Extended observations made upon the cow, the 
mare, and the sheep confirm the results observed in the 
human female. In the cow, the average period of gestation 
is about 285 days; yet, from Dr. Krahmer's tables, it is 
found that, out of 11 05 cows, 335 calved on the fortieth 
week, 429 on the forty-first week, and 135 on the forty- 
second week ; the balance varied from the thirty-eighth week 
to the fifty-first week — a period of about 90 days. 

In sheep ^ the average time among 177 births examined, 
was 150 days; yet the period varied from 145 to 171 days — 
a difference of 26 days. 

In mares, whose normal term of gestation is about 300 
days, Tessier found, out of 102, that 21 went as far as 360 
days, and one as far as 394 days. 

The logical conclusion from the above statements must 
be that it is possible for human pregnancy to be prolonged 
beyond the usually admitted normal period ; but the ques- 
tion how far beyond, is rather difficult to answer; though 
the greater the amount of deviation, the stronger and more 
convincing should be the proofs. 

It is an error to suppose that a protracted pregnancy is 
accompanied by an increased size of the child, although, 
physiologically considered, the foetus ought to continue to 
increase in size hi iitero after the usual term of gestation. 

The celebrated Gardrier Peerage Case well illustrates 
many of the above points. Lord and Lady Gardner parted 
from each other on January 30th, 1802. The husband 
returned on July nth, of the same year. During his 
absence, his wife was known to be living in adulterous 



500 MEDICAL JURISPRUDENCE. 

intercourse with a Mr. Jadis. She was deHvered of a son on 
the 8th of December, three hundred and twelve days after 
Lord Gardner's first absence, and one hundred and fifty 
days (about five months) after his return. The child was 
perfectly developed, and mature at its birth, so that the idea 
of a premature birth was not entertained ; and the only 
question was as to the possibility of a protracted gestation. 
The ablest obstetrical experts were engaged on both sides, 
at the trial, and, as usual, there was a difference of profes- 
sional opinion upon the subject, some maintaining that the 
period of gestation was absolutely fixed, while others (the 
majority) admitted the possibility of its being protracted. 
The case was decided against the claimant (the alleged son), 
not, however, on the ground of the protracted period of his 
birth, but on the ground of his mother's notorious adul- 
tery, and her concealment of his birth. 

A circumstance often lost sight of in this discussion is, 
that conception is not always synchronous with intercourse 
or " insemination." The former occurs only when the 
spermatozoids come in actual contact with the ovum. This 
may take place in the uterus, or in the Fallopian tube; and, 
according to Raciborski and Bischoff, several days may 
elapse, after intercourse, before it is actually accomplished. 
The spermatozoa are known to retain their vitality for a 
period of seven days within the vagina; and as fecundation 
cannot result until these meet the matured ovum (which 
requires a variable period for its descent from the ovary), 
conception might be delayed as long as seven days. But 
this does not explain the lengthened variations of gestation 
alluded to above. We must, therefore, in the language of 
Dr. Taylor, " be prepared to admit either that conception 
may, in some cases, be delayed for so long a period as five 
to seven weeks after intercourse, or that there may be a 



LEGITIMACY PREMATURE BIRTH. 501 

difference of from five to seven weeks in the duration of 
pregnancy." 

11. Premature birth. — Diminished period of gestation. — 
Early viability. — An important question in connection with 
Legitimacy is, whether a child, in all points fully developed, 
can be born before the ordinary period of gestation ? Its bear- 
ing upon the subject of Legitimacy is direct and important. 
For instance, a husband, after a long absence, returns to his 
wife, and a fully-developed child is born after seven or 
eight months : Is this a legitimate child? The question is 
about as difficult to determine as the former one concerning 
a protracted pregnancy. It must be admitted that children 
at full term differ extremely in size, weight, and in apparent 
maturity, so that some eight months' children may appear 
better developed than some at nine months. This, however, 
is the exception, and not the rule. Again, it is known that 
some women always give birth to their children before the 
full term ; but these may be regarded as cases of diseased 
action. The probabilities are strongly against it. 

Again, since, in cases of prolonged gestation, the children 
do not continue to grow in utero after their full period, it 
would seem still less probable that, in the earlier months of 
foetal existence, they should be one, two, or three months in 
advance of their normal intra-uterine life. Dr. Montgomery 
says, that he never saw a seven months' foetus present the 
remotest appearance of the fully matured child. 

We are, therefore, of the opinion that, while in some 
instances there may be a doubt about an eight months' 
child, on account of its advanced degree of development, 
there ought to be no doubt whatever in the case of a six, 
or seven months' child. The peculiar characters presented 
by the foetus at these ages are given, {ante p. 447). 



502 MEDICAL JURISPRUDENCE. 

In an English case, where the question of the legitimacy 
of a child was made to depend upon the period of the 
mother's gestation — 259 days, or 37 weeks (or three weeks 
lacking maturity), Sir J. Simpson gave evidence that a child 
born, perfectly matured, three weeks before the usual term, 
could not be legitimate. This is certainly stronger ground 
than we would venture to take. To bastardize a child, and 
to impute the crime of adultery to the mother, because of 
the three weeks' prematureness of the birth, even though 
apparently mature, is, we think, an assumption not warranted 
by numerous facts. 

As regards the earliest viability of a child, or the earliest 
period of birth when it is capable of living, there is a uni- 
versal admission that an eight, or even a seven months' 
child may survive ; that occasional instances have occurred 
where a six months' infant lived; and that a very few excep- 
tional cases have been recorded of the survival of children 
born a little over five months. An infant born earlier than 
this period could not be considered viable. 

But the question of premature birth may present itself 
under another aspect, of a civil nature, viz., that of survivor- 
ship, where a livijig child acquires civil rights, such as in- 
heritance, and the transmission of property. In such a 
case, it becomes a matter of vital importance to establish 
the fact that the child, when born, was actually alive. The 
laws of this country and of England do not require that 
the child should be viable, i. e., capable of continuing to 
live, but only that it should be born alive. It matters not 
whether it be mature or immature, so that it was alive. 

What, then, constitutes a live bh'th ? We reply, anything 
that will prove that the child was living at the time of its 
birth. According to the laws of the United States and 
England, neither breathing nor crying are essential to 



LEGITIMACY LIVE BIRTH. 503 

establish a live birth ; the pulsation of the child's heart, or 
of one of its arteries, or the slightest voluntary movement, 
is regarded as sufficient for this purpose. In Scotland, cry- 
ing is regarded as essential ; in France, respiration ; and in 
Germany, crying, " attested by unimpeachable witnesses." 
According to Blackstone, crying, indeed, is the strongest 
evidence, but it is not the only evidence; and Coke remarks — 
" If it be born alive, it is sufficient, though it be not heard 
to cry, for peradventure it may be born dumb." 

With this clear and definite understanding of what is 
legally regarded as the proofs of a live birth, we must admit 
that foetuses have been born alive as early as four months, 
and, of course, at all periods of a later date. Such a case is 
reported by Dr. Erbkam, of Berlin, when the foetus was only 
six inches long, and weighed but eight ounces ; it survived 
half an hour; it moved its legs and arms, turned its head 
from side to side, and opened its mouth. Miiller pro- 
nounced this foetus to be not over four months old. Dr. 
Barrows, of Hartford, reports another case, especially inter- 
esting, from the fact that the exact period of conception 
could be fixed; miscarriage took place at 144 days — less 
than five calendar months. The ovum was expelled entire. 
Before rupture of the membranes the movements of the 
child were vigorous. After the rupture it cried out very 
distinctly ; the cord was tied on ceasing to pulsate, after 
which it breathed with a gasp for forty minutes ; it repeat- 
edly opened its mouth, and thrust out its tongue. It 
measured ten inches long, and weighed fourteen ounces. 



604 MEDICAL JURISPRUDENCE. 

SECTION II. 

TENANCY BY COURTESY. — LAWS CONCERNING LEGITIMACY. — PATER- 
NITY. — AFFILIATION. — SUPERFCETATION. — DOUBTFUL SEX IN HER- 
MAPHRODITISM. 

Tenancy by Courtesy. — This phrase signifies, according to 
Blackstone, "a tenant by the courts of England," and is 
applied to the case where a husband of a woman who dies 
possessed of an estate acquires a life-interest in the property, 
provided a child was born of the marriage, //z//;^^, during the 
wife's hfe. " In this case " (in the old law language) " he shall, 
on the death of his wife, hold the lands for his life, as tenant 
by the courtesy of England." If there should be no living 
issue, the property would pass to the heir-at-law. In every 
such case the following conditions must be settled : (i) there 
must be proof of a live birth (vid. ante, p. 502). We have 
already adverted to the proofs required to establish a live 
birth in different countries. (2) The child must be born 
while the mother is living. This was the old dictum of 
Lord Coke some three hundred years ago. Hence, if a 
living child were extracted by the Caesarean section from a 
dead mother, it could not transmit an inheritance. Dr. 
Taylor very properly doubts if this doctrine would be 
followed by modern courts. (3) The child must be born 
capable of inheritijtg; therefore, a monster cannot inherit, or 
transmit a property. It is difficult to give a legal definition 
of a " monster." Clearly, no mere external deformity or 
internal malformation would constitute such a disability. 
Lord Coke defines a monster " as a being that hath not the 
shape of mankind." Thus, an acephalous, dicephalous 
or disomatous creature would seem to be excluded. St. 
Hilaire's distinction in relation to such beings is usually 
followed, viz., to consider every monster with two equally- 
developed heads, whether disomatous or not, as two distinct 



LAWS CONCERNING LEGITIMACY. 505 

beings, and every monster with a single head, disomatous 
or not, as only one being. It is difficult to say how such a 
ruling would apply as to the exclusion of such cases as the 
Siamese twins ^ and others somewhat similar. In several of 
our own States, the old English law of the '' Tenancy by 
Courtesy " still prevails. A few years ago, the author was 
called, as an expert, in the State of Delaware, to sustain the 
alleged fact of the live birth of a child which had neither 
breathed nor cried, but whose heart and temporal arteries 
had pulsated for several minutes after birth. The opposite 
party adopted the usual course in such cases, namely, to 
assert that these acts of the circulation " were only the rem- 
nants of uterine life." But it was conclusively shown that 
every action of a person's life may be regarded as " the rem- 
nant of uterine life," and that, as such acts could not be 
performed by a dead child, the only alternative was to admit 
that it was alive. 

Laws concerning Legitimacy. — The Roman law did not 
consider a child legitimate if born later than ten calendar 
months after its father's death. The French law allows the 
legitimacy of a child born i8o days (or six calendar months) 
after marriage, and 300 days after the death, or non-access of 
the husband. The Prussian law declares a child legitimate 
that is born within 302 days after the husband's death. In 
Scotland, the legitimacy of a child is established if it is born 
168 days (six lunar months) after marriage, and within ten 
months after the death of the husband. In ih.Q Jadine case, 
the General Assembly of the Church of Scotland pro- 
nounced in favor of the legitimacy of the child which was 
born 174 days after marriage. 

In this country and in England, there is no law regulating 
the exact period of gestation in relation to legitimacy, every 



506 MEDICAL JURISPRUDENCE. 

case being decided on its own merits. In the United States, 
in one instance, legitimacy was allowed where the time was 
317 days; and in another case, affiliation was allowed where 
the period was 313 days. In England it was disallowed 
(Gardner Peerage Case) where the time was 311 days; but, 
as was remarked above, the moral circumstances of this 
case, rather than the question of a protracted gestation, 
influenced the decision. 

Minority and Majority. — In law, the word minor or 
infant signifies a person under the age of twenty-one years. 
Before this age, he or she is regarded as incapable of perform- 
ing certain civil acts, such as serving on a jury, making a will, 
executing a deed, or other contract. The law has fixed no 
age for competency as a witness, the court judging, in indi- 
vidual cases, of the mental capacity of the child. It is 
usually held that a child up to seven years is incapable of 
distinguishing right from wrong, and is, therefore, legally 
incapable of crime. At fourteen, a child is considered to 
have arrived at years of discretion, and it then becomes 
responsible for its actions, as for murder, or rape. 

A person attains legal majority the first instant of the day 
before the twenty-first anniversary of his or her birthday, 
although forty-seven hours and fifty-nine minutes short of 
the complete number of days, counting by hours. This is 
on the principle that a part of a day is, in a legal point of 
view, equal to the whole of a day. Hence the importance 
of noting the exact day and hour of a child's birth, as a few 
minutes or hours may thus determine the attainment of 
majority (Taylor). 

Paternity. — Affiliation. — The question of Paternity 
may present itself under various forms ; as, where a woman 



PATERNITY AND AFFILIATION. 507 

marries a month or so after the death of her first husband, and 
a child is born in about ten months afterwards ; also where 
a suppositious child claims to be heir of an estate ; and still 
more frequently, in cases of bastardy, where the putative 
father is obliged to support the child. In all such cases, 
likeness to the parent is regarded as strong presumptive 
proof of paternity, requiring, however, further corroboration. 
This paternal resemblance extends not only to the features, 
but also to the voice, gesture, attitude, and habits. 

Paternal likeness may obviously be shown by color, 
as where a white woman gives birth to a mulatto, or Mongo- 
lian child, or vice versa. 

Personal deformities are sometimes, though not always, 
transmitted from parent to child ; but, certainly, it would 
not be safe, in a disputed case of paternity, to make the 
decision solely to depend on this. In some alleged cases of 
this nature, it is quite possible that the mind of the female, 
while pregnant, might have been influenced by the mere 
sight of the deformed man alleged to be the father of her 
child. 

In the Douglass Peerage Case^ this question of paternity 
was the turning point as to whether the claimant, Archi- 
bald, was the true and lawful heir to the title and estate. 
The case was tried in 1767, in the Court of Session, in 
Scotland, and lasted eight days. Out of fifteen judges, 
eight decided against the appellant. The case was then 
appealed to the House of Lords, which reversed the former 
decision. Lord Mansfield delivered the judgment, and took 
occasion to express a very decided opinion in favor of the 
parental likeness which the claimant bore to his father, as 
constituting an important link in the chain of evidence. 

A case oi affiliation may present itself, where a child, born 
of a woman who had intercourse with two men within a 



508 MEDICAL JURISPRUDENCE. 

few days of each other, is affiliated upon one of the men, 
rather than upon the other. Here it would be impossible 
to settle the question by a mere medical opinion. The cir- 
cumstances of color, or other likeness, or some accident, 
might possibly determine it; but it would seem more just 
and equitable that each putative father should contribute an 
equal share towards its support 

Connected with the question of paternity there is a 
curious physiological fact that might occasionally be sup- 
posed to affect the decision. It is known to breeders of 
horses and cattle that the influence of the impregnation by 
one sire may be extended beyond the foal begotten at the 
time, and affect those begotten subsequently by another sire. 
This is proven by the later colts, or calves bearing the 
peculiar markings of the first sire. The question, there- 
fore, might be suggested whether this same handing down 
of parental likeness to the children of a subsequent father 
might be possible? Without any positive data on which to 
venture an opinion, it may, nevertheless, be suggested here 
as a circumstance to be considered in certain cases of 
affiliation. 

SuPERFCETATiON. — By this term is implied the conception 
of a second embryo in a woman already pregnant, and the 
birth of two children at one time, differing considerably in 
their maturity, or of two births at different times, of mature 
children. The possibility of a second conception after a 
successful impregnation is denied by some authorities ; but 
the proof of it is abundantly established by the fact of a 
woman giving birth to two children of different colors, and 
her admitting to have had intercourse with a white and 
black man successively. It must also be accepted as pos- 
sible in the case of a double uterus. The usual explanation 



SUPERFCETATION. 509 

given by those who reject the doctrine is, that there was a 
tzvin conception, and that one of the embryos became 
bhghted in early uterine Hfe, while the other continued to 
be developed. This explanation might cover some cases 
of alleged superfoetation, but certainly not all, as where two 
perfectly mature children are born three or four months 
apart. 

It has been maintained that superfoetation is impossible, 
because of the physical obstacle to the entrance of the 
seminal fluid into the mouth and neck of the uterus, caused 
by conception. This, however, has been denied by Dr. M. 
Duncan, who has shown that the mouth of the womb is not 
immediately closed after conception, and that communica- 
tion between the vagina and ovary is not cut off for several 
months after impregnation, and that there is no impediment 
to the ascent of the spermatozoa. Others attribute the 
rarity of superfoetation, not so much to any mechanical 
impediment, as to the absence of proper ovules — ovulation 
(menstruation) being of rare occurrence in the pregnant 
condition. 

Double conception has been observed in the lower 
animals, as in a mare covered successively by a horse and 
an ass; she produced at the same birth a horse and a mule. 

The result of all the observations made upon this subject 
is, that the majority of the alleged cases of superfoetation 
may be explained (i) upon the theory of twin pregnancies, 
where one foetus has grown at the expense of the other, 
and is first expelled, the other remaining until it has 
acquired the proper maturity; (2) by the existence of a 
double uterus. Nevertheless, there are a few other cases 
which do not admit either of these explanations, and which 
cannot be accounted for except on the theory of two suc- 
cessive conceptions. 



610 MEDICAL JURISPRUDENCE. 

Doubtful Sex. — Hermaphroditism. — This latter term 
strictly applies to those cases in which the organs of both 
sexes exist in the same individual ; but it is now commonly- 
employed to designate all cases of doubtful sex. The 
causes of these departures from the usual form must be 
referred to some abnormal change in the sexual organs in 
early embryonic life, causing an arrest in development, and 
a defect in some parts. With this defective sexual develop- 
ment, there are usually associated certain peculiarities which 
indicate the preponderance of one or other of the sexes. 
Until the period of puberty it is often difficult to determine 
the particular sex of the individual. At this epoch, how- 
ever, certain changes usually occur that show the prepon- 
derance of either the male, or female sex, such as change of 
voice, greater development of the shoulders or hips, the 
appearance of a beard, the development of the breasts, etc. 
The mere absence of testicles does not prove that it is not 
a male, since the testes sometimes never descend into the 
scrotum. Neither does the presence of a beard and whis- 
kers necessarily indicate that it is not a female. We have 
seen a woman with as flowing a beard as is found on most 
males. In some cases, an external examination may fail to 
indicate the sex; the clitoris maybe mistaken for the penis, 
the labia for the scrotum, and the prostate gland for the 
uterus. Even a post-mortem investigation may not always 
succeed in clearing up the uncertainty. 

Important medico-legal relations may have to be deter- 
mined in cases of doubtful sex. Such beings, on account 
of imperfect sexual development, are impotent and sterile, 
hence, questions of divorce, legitimacy of offspring, pater- 
nity and affiliation may be raised. Such beings cannot be 
deprived of the right of inheritance, nor (in our country) 
of the right of voting, if medical testimony shows a pre- 



IMPOTENCE. 511 

ponderance of the male peculiarities. In case of inheritance 
depending upon the sex of the offspring, when the estate 
and title descend to the first born male^ if the offspring 
should prove to be of doubtful sex, the preponderance of 
the male peculiarities would have to be clearly established 
by a medical examination, before the inheritance could be 
claimed. 

A very extraordinary case of successful coiiceahnent of 
sex is that of Dr. James Barry, who was Staff Assistant 
Surgeon in the British army, and who died in 1865, at 
eighty years of age. This person was really a woman, as 
was proved by an autopsy. During this long period, she 
had managed effectually to conceal her sex, although 
effeminate in appearance, and without beard. She passed 
her medical examination, and served in the army in different 
quarters of the globe, and exhibited all the usual qualities 
of a good soldier during her active life. 

SECTION III. 
IMPOTENCE.— STERILITY. 

IMPOTENCE. — CAUSES. — PROCREATIVE POWER IN THE MALE. — CRYP- 
SORCHIDES AND MONORCHIDES. — STERILITY. — PROCREATIVE 
POWER IN THE FEMALE. — LEGAL DECISIONS. 

Impotence, or the want of procreative power in the male, 
may depend upon functional, or organic causes. The 
functional include certain functional, debilitating diseases, 
masturbation, the opium habit, and alcoholism. The organic 
comprise malformation of the genital organs, such as defi- 
ciency of the penis, fistula in perineo, castration of both 
testicles, cancer or other malignant disease of the testes, 
and malformation of the urethra, as hypospadias and 
epispadias. Some of these defects are remediable, whilst 



512 MEDICAL JURISPRUDENCE. 

others are not. The mere absence of the testes from the 
scrotum does not produce impotence, for such persons 
{cry psvr chides) are capable of begetting children. 

In professional language, the term impotence is applied to 
the male, while the term sterility usually refers to the same 
condition in the female, including both a physical sexual 
incapacity for intercourse, and also unfruitfulness. A dis- 
tinction, however, should be made. Strictly speaking, the 
male may be sterile without being impotent, as is seen in 
cases after castration, and in some crypsorchides ; or he may 
be impotent without being sterile, as when intercourse is 
prevented by physical malformation, although the testes 
may secrete healthy semen. Again, the female may be 
unfruitful without being incapable of intercourse, or vice 
versa. As regards the legal disqualification of the male, on 
the ground of impotency, all that is necessary to prove is 
simply impotence, or the incapacity for intercourse. In the 
female, incapacity for sexual intercourse (not sterility) can 
alone be adduced as a ground for divorce. 

The procreative power in males usually commences at 
puberty, with the fi^ll development of the sexual organs, 
especially the testes. The exact age of male puberty varies, 
but it may be stated to be from fourteen to seventeen years. 
Until this period is attained, the semen does not contain the 
spermatozoa, on which alone its fecundating power depends. 
Doubtless, certain cases of sterility are dependent on the 
absence of these zoosperms from the seminal fluid. It 
would also appear that the power of impregnation is 
dependent on the activity of movement of these little 
bodies. The impotence of old age in the male is probably 
owing to the feeble motion of the spermatozoa, rather than 
to their deficiency. 

The procreative power in the male may continue to very 



IMPOTENCE STERILITY. 513 

advanced age, if conjoined with sound bodily health. 
Spermatozoa have been found in the semen at the age of 
eighty years ; and even above. Certain diseases impair and 
destroy this power, such as disorders of the brain and spinal 
cord, dropsy, malignant fevers ; also blows on the head and 
spine. 

The procreative power in the female. — The term sterility, 
when applied to the female, is usually understood to mean 
an inability to conceive. This power is manifested at puberty 
or when the function of menstruation first appears. The 
precise age when this occurs differs in different countries, 
and with individual females, the usual earliest periods being 
twelve and thirteen years (some exceptional cases as early 
as under one year, and upwards), and the latest periods 
nineteen to twenty-three years. Conception, however, may 
take place in women who have never menstruated ; and in a 
few exceptional instances the function never occurs through- 
out the life, although the woman may have given birth to 
several healthy children, and enjoyed good health herself 

Instances of premature puberty are not uncommon. 
Cases are reported where girls, one, two, or three years old, 
have exhibited the physical development of grown women, 
and in whom the catamenia appeared at this early age, and 
the function was regularly performed. Menstruation ceases, 
in the majority of cases, at forty to fifty years of age, but 
there are many exceptions. As it may commence early, so 
it may terminate late — even up to sixty or seventy years, 
and in some remarkable instances, even to eighty, or ninety 
years. 

The continuance of menstruation is usually indicative of 

the power of conception. Its termination nearly always 

marks the cessation of the woman's ability to bear children. 

But it is undeniable that women have conceived after the 

23 



614 MEDICAL JURISPRUDENCE. 

cessation of the catamenia. The latest age for pregnancy 
cannot be absolutely fixed, although it is comparatively rare 
after forty-five years, and almost unknown after fifty-five 
years. 

The causes of sterility in the female are various ; some are 
organic, such as absence of the uterus, or the ovaries, or 
disease of these organs ; imperforate vagina or hymen ; 
ovarian and uterine tumors ; occlusion of the os uteri by 
constriction ; malposition of the uterus, etc. Other causes 
are functional, as debility, excessive leucorrhoea, dysmen- 
orrhoea, amenorrhcea, menorrhagia, etc. It must also be 
remembered that women may be sterile with one man and 
fertile with another, as is stated to have occurred in the case 
of two men who, traveling together with their wives to 
drink the waters of some celebrated spring, accidentally and 
unconsciously exchanged wives at an inn, when both wives 
became pregnant. It not unfrequently happens that a 
woman who has been married for years without issue, in 
contracting a second marriage, may have several children. 

Legal relations. — A suit for divorce may be procured by 
either party on the ground of impotency, provided it can be 
shown that the incapacity existed at, and before marriage, 
and that it could not be remedied. There should be no 
delay in bringing the suit, and there should be proof that 
the incapacity was unknown to the complaining party at the 
time of the contract. If the alleged cause has supervened 
after the marriage, there can then be no grounds for a 
divorce. To sustain this charge of incapacity, a medical 
examination is essential, but this must be voluntary on the 
part of either the man or woman ; the court cannot compel 
it. In the event of a refusal to submit, the case would have 
to be decided on partial evidence, and probably this would 
be adverse to the party so refusing. A mere unwillingness 



IMPOTENCE STERILITY. 515 

to submit to sexual intercourse on the part of a wife, or 
what the law terms " a frigidity of constitution," would not 
justify a legal divorce. There must be proof of sexual 
incapacity from physical defect in either party. 

Certain cases of hysteria and of vaginismus^ where 
intolerable pain, and even spasm is produced in the woman 
at every attempt at intercourse, might possibly be regarded 
as affording legal grounds for a divorce. It was so deter- 
mined in one case of hysteria in England ; but as the other 
affection (vaginismus) is often remediable, it is doubtful if 
the courts would regard this as a sufficient cause for 
granting it. 



516 MEDICAL JURISPRUDENCE. 



CHAPTER XXXVII. 

RAPE. 

SECTION I. 

LEGAL MEANING. — DUTY OF THE EXAMINER. — RAPE ON CHILDREN. — 
MAY BE CONFOUNDED WITH DISEASE. 

Rape is legally defined to be the " carnal knowledge of a 
woman forcibly, and against her will." In ancient times, 
this crime was variously punished by death, castration, fine 
and imprisonment. At the present day, both in our own 
country and Great Britain, it is regarded as a felony, and is 
punished by imprisonment, or penal servitude for a term of 
years. In England, until the present reign, death was the 
punishment for rape, and it is said that since this alteration 
in the law, " the crime has increased from fifty-seven to 
ninety per cent, in four years." 

As this crime is usually committed in secret, and without 
witnesses, the law receives the evidence of a single person 
(the prosecutrix) as sufficient to establish the charge. As, 
however, false accusations are exceedingly common (twelve 
false to one true, according to Prof Amos), medical evidence 
is generally required as corroborative proof In former 
times the law required proofs, both of penetration and emis- 
sion on the part of the male ; at present, it is only requisite 
to adduce proof of vulval penetration, and without, neces- 
sarily, rupture of the hymen. 

Rape on young children is far more common than on 
adult women ; and for this several reasons are assigned. 
The most obvious one is the comparative facility of the 
attempt, on account of the feebleness of resistance, and the 



RAPE. 517 

ignorance of children. Another reason alleged, particularly 
in the Old World, is a prevailing superstition among the 
lower orders that an obstinate gonorrhoea is most certainly 
cured by having intercourse with a pure virgin ; and, there- 
fore, a young child is selected for this revolting crime. 

The consent of the female does not excuse the act, if she 
be under ten years of age ; if she is between ten and twelve 
years, it is only a misdemeanor ; and if over twelve years, 
and consent is given, it is no longer legally a crime. In 
cases of the idiotic, or feeble-minded, or insane, the consent 
of the female is usually regarded as not excusing the crimi- 
nality of the act; but, in these instances, each individual case 
should be decided according to the special circumstances, 
as the degree of mental imbecility, the proof of consent, 
and the employment of force on the part of the man. 

In the case of an alleged rape, .the duty of the physician 
snmmoned is, first of all, to make a note of the exact time 
and date of his examination, since this may hereafter serve 
an important purpose for the defence, to enable him to show 
that the prosecutrix did not take the earliest opportunity to 
complain. The time of the alleged offence should also be 
noted, as this also may enable the accused party to prove 
an alibi. The female should be visited without giving her 
time for preparation, and the examination at once be made; 
but it should be remembered that this examination cannot 
be compulsory, although, if refused, this would be a strong 
circumstance against the truth of the accusation. Medical 
evidence is derived (i) from marks of violence about the 
genital organs ; (2) from bruises, wounds, or other marks 
of injury on the person of the woman, and also of the 
accused ; (3) the presence of spermatic and blood stains on 
the person or clothing of either, or both ; (4) the existence 
of gonorrhoea or syphilis on one, or both. 



518 MEDICAL JURISPRUDENCE. 

Unless the examination be made very soon after the act, 
all traces of it may have disappeared. Three or four days 
may suffice for this ; yet, practically, in most cases, days or 
months will elapse before an examination of the alleged 
victim is instituted, and mistakes consequently often result. 
Casper states that in fifty-eight cases he examined, the time 
that had elapsed from the alleged commission of the rape 
varied from three weeks to one year. 

Rape on Children. — The fact of the greater frequency of 
rape upon children has already been stated. Out of ii i cases 
examined by Casper, the ages were as follows : seventy-eight 
from two and a half up to twelve years ; seventeen from twelve 
to fourteen years ; seven from fifteen to eighteen years ; and 
seven from nineteen to twenty-five years. Hence, it follows 
that over severity per cent, of the cases are below twelve 
years of age. It is quite probable that this proportion 
would be found to exist also in other countries. But it 
should not be forgotten that many alleged cases of rape on 
young children are entirely fraudulent, trumped up by the 
vile accusers (usually mothers), chiefly for extorting money 
from innocent men. Casper mentions numerous instances 
of this character. He states that out of thirteen cases he 
examined, he found nothing whatever to support the accu- 
sation, although other physicians had pronounced them 
genuine, and some of them even exhibiting marks of 
chancre ! In all genuine cases, the genital organs should 
exhibit marks of injury, if the act has been completed, and 
especially if any resistance was made, such as laceration of 
the pudendum, the effusion of blood, and bruises of the 
neighboring parts. It is manifestly impossible, from the 
disproportion between the sexual organs, that a rape could 
be perpetrated by a man upon a young child without being 
attended with severe local injuries to the latter. 



RAPE ON CHILDREN. 519 

If the child be examined within two or three days after 
the act, the following signs will usually be found : inflam- 
mation and tumefaction of the vulva, with some abrasion of 
the mucous membrane ; a muco-purulent discharge from 
the vagina, of a yellowish or greenish-yellow color, and ropy 
consistence, staining and stiffening the girl's linen ; painful 
urination, arising from the inflammation bsing extended to 
the urethra ; clots of blood lying in the vulva, and blood 
oozing from the abraded membrane. The hymen may be 
found either destroyed or lacerated, or very possibly not 
injured at all. In relation to the condition of the hymen in 
very young children, it should be remembered that in them 
it presents a variety of conformation, sometimes being very 
far back in the vulva, so as to render it difficult to find ; \x\ 
such cases it may entirely escape laceration. In fifty -four 
cases of actual rape upon children, many of them under 
fourteen years of age, and complicated with syphilis, Casper 
found the hymen uninjured m foitr-fifths of the number. 

Unnatural dilatation of the vagina may be mentioned as 
a frequent sequence of rape on young children; but this 
condition may be produced by the passage of hard bodies 
in order to substantiate a false charge. Casper once 
examined a girl only ten years old, whose mother had 
gradually dilated her vagina with her fingers, in order to fit 
her for sexual intercourse with men ! 

In making a medico-legal examination m the case of an 
alleged rape on a child, several points are to be considered. 
In the first place, it should be recollected that for the legal 
establishment of the crime, both in children and adults, it 
is only necessary that vulval penetration^ however slight, be 
proven. It is not required that the hymen should be 
destroyed. It has so been decided in repeated cases. If, 
after an early examination, no marks of violence about the 



520 MEDICAL JURISPRUDENCE. 

sexual organs, or other portions of the person are discovered, 
this would be a strong presumption against the validity of 
the charge. On the other hand, the mere presence of marks 
of violence about the pudendum is not of zVi-^^ sufficient to 
prove a rape, since these are sometimes inflicted purposely 
upon young children, by designing mothers, in order to make 
out a false charge against an innocent man. Further, the 
absence of the hymen is not of itself a proof of rape, since 
this membrane may have been previously destroyed by 
suppurative inflammation, or by ulceration, also by 
accident, or even designedly, in order to substantiate a 
false charge. 

The question whether gonorrhoea or syphilis could be 
communicated to young children otherwise than by sexual 
contact must, we think, be answered affirmatively, though 
only in exceptional cases, as by the use of sponges or 
cloths which have been previously employed by adults 
affected with these disorders. Such instances, however, are 
extremely rare ; but they might be accepted as probable 
where no signs of violence, or soreness of the parts existed. 
The muco-purulent discharge which invariably follows 
upon the defloration of a young girl, should not be con- 
founded either with gonorrhcEa, or with infantile leucoj^rhoea. 
The latter disorder is of spontaneous origin, and is very 
common among children of the lowest orders, whose 
hygienic surroundings are bad, who are often strumous, 
and otherwise unhealthy. The existence of this discharge 
is not unfrequently made the ground of complaint against 
an innocent man, for a felonious assault upon the person of 
the young girl, who has been previously tutored by her 
unprincipled mother to tell her story, even to its minutest 
details. In cases of this kind, it is always best to examine 
the over-anxious parent and the child separately, and apart ; 



RAPE ON CHILDREN. 521 

and allow the latter to tell her own story without prompt- 
ing, and then to cross-examine her. 

Gangrenous i7iflainmation of the vulva {noma pudendi) is 
more rare than infantile leucorrhoea ; it sometimes prevails 
epidemically, and occurs as a sequel to low fevers, and 
other prostrating- diseases ; it is found almost exclusively 
among neglected, filthy children, suffering from exhaustion 
and want of food. The mortification in these cases fre- 
quently terminates fatally. 

To diagnosticate properly between these spontaneous 
infantile diseases and a gonorrhoea, or a muco-purulent dis- 
charge (the result of a sexual connection), the examiner 
should remember that a true gonorrhceal discharge does not 
come on until about the fourth to the eighth day, and is 
usually very profuse — much more so than that which results 
simply from the violence of defloration; also, that its dura- 
tion is much longer. Casper recommends that, in doubtful 
cases, a second examination should be made in the course 
of a week or ten days. If the purulent discharge has then 
ceased, or is about ceasing, there is good reason to believe 
that it was not due to gonorrhoea. Again, if the muco- 
purulent flow is of spontaneous origin (leucorrhoea), there 
will be an absence of blood ; whereas, if it be due to vio- 
lence (rape), there will always be more or less effusion of 
blood, along with dilatation, and probably laceration, of the 
vagina, and rupture of the perineum. In all such cases, 
the person of the accused should be examined for evidences 
of gonorrhoea, and also for blood stains upon his person or 
clothes ; but the absence of the latter would be no proof 
that he had not committed the crime, since the bleeding of 
the pudendum may not have taken place until after the 
act. Several cases of this character have been reported. 
Moreover, the discovery of seminal stains, upon either the 
23* 



522 MEDICAL JURISPRUDENCE. 

accused or the victim, might be regarded as positive proof 
of guilt, unless it could be shown that a previous and recent 
defloration had occurred. 

Rape on young children has not unfrequently resulted in 
death ; the violent laceration of the vagina and perineum 
producing, in some instances, mortification, and in others 
fatal peritonitis. 

SECTION II. 
RAPE ON ADULT WOMEN. 

POSSIBILITY OF, WITHOUT CONSENT. — IF UNCONSCIOUS. — EFFECTS OF 
ETHER. — CASE OF C077l. VS. Beale. — EVIDENCES OF RAPE ON 
ADULTS. — CONDITION OF THE HYMEN. — SEMINAL STAINS. — EVI- 
DENCES OF RAPE ON THE DEAD. — UNNATURAL CRIMES. — LEGAL 
RELATIONS OF RAPE. 

The question is frequently raised as to the possibility of a 
rape being committed, by one man, upon a healthy, vigorous, 
adult woman. The answer to the question will, to a great 
extent, depend upon the relative strength of the contending 
parties. As a general rule, we think that a determined and 
vigorous resistance, in the supposed, case, would prevent 
the perpetration of the crime. But, on the other hand, the 
woman may be forced to yield through fear of her life, or 
duresse, or may be actually overpowered through superior 
strength. Casper gives an instance where a healthy, strong 
adult, twenty-five years old, was violated by a single man. 
Every case of this character must be judged on its own 
merits. The medical jurist has simply to state, from an 
examination of the parties, that sexual intercourse has 
taken place, leaving the jury to decide whether or not rape 
has been perpetrated. Doubtless, in some such false accu- 
sation of rape, Sancho Panza's mode of sifting the evidence 
and his subsequent judgment in the case, during his brief. 



RAPE ON ADULT WOMEN. 523 

though briUiant, experience as Governor of Barataria, might 
be held up as a safe guide to follow {Don Qidxotte, Vol. II, 
p. 289). In some cases, there are accomplices to the crime, 
when, of course, there can be no hesitation as to the possi- 
bility of overcoming the resistance of the victim by mere 
brute force. 

It must also be admitted that rape may be perpetrated on 
adult women when rendered unconscious by means of 
powerful narcotics or anaesthetics, or when thrown into the 
mesmeric condition, or when in the coma of apoplexy ; but 
whether the act can be accomplished when the female is 
merely in a profound natural sleep, and unconsciously to 
herself, is a question which admits of considerable discussion. 
The cases of this character are certainly exceptional ; still 
we think their possibility must be admitted — certainly in 
the case of women accustomed to sexual intercourse, but 
very doubtful in the case of virgins; although we may not 
deny the possibility , even in the latter, inasmuch as authentic 
instances are mentioned by reliable authors ; but there will 
always necessarily be more or less doubt in the matter, and 
the oft-quoted dictum of Valentin deserves consideration : 
" non omnes dorniiunt qui clausos habent ocnlos!^ 

A medico-legal question of much importance is, whether 
the anaesthetic effects of ether and chloroform are capable 
of so completely abolishing consciousness and sensibility on 
the part of a woman, especially a virgin, as to permit the 
successful perpetration of a rape ? A somewhat remarkable 
case involving this question was tried in Philadelphia in 
1854 {Com. V. Beale), The plaintiff was a young lady of 
unimpeachable character, who charged a very respectable 
dentist with committing a rape upon her, while in his office, 
and under the anaesthetic influence of ether for the purpose 
of an operation upon her teeth. She averred very positively, 



524 MEDICAL JURISPRUDENCE. 

in her testimony, that she was conscious of his "entering her 
person," and then "felt pain," but she "was not able to cry 
out or resist," and " all this time was conscious of everything 
that was going on." She afterwards " opened her eyes" and 
again " closed them immediately." After this alleged 
liberty, she states that she inhaled the ether the second time, 
at the doctor's request, in order to have a tooth extracted. 
When this was over, she made a second appointment with 
him for some days after. She parted with the dentist at his 
front door, without making any complaint, leaving a kindly 
message for a mutual acquaintance. From his office she 
Avalked a considerable distance to a friend's house, stopping 
on the way at a confectioner's, to partake of ice cream. 
After her visit to her friend, she again walked quite a dis- 
tance to another friend's house, where she remained several 
hours, and after tea on that same evening first informed any 
one of the alleged outrage ; and on the same afternoon her 
catamenia appeared, which was her regular time. She 
further stated that " she did not examine her person before 
the appearance of the menses, nor did any body examine 
her garments before two days had elapsed. She was never 
examined by any physician!' Her complaint was lodged 
before the Mayor, and the defendant was arrested, tried 
convicted, and imprisoned for a term of years. 

The general opinion of the medical and legal professions, 
both at the time of this trial and since, was that this convic- 
tion was unjust, and unwarranted by the circumstances of 
the case. The most serious defect in the evidence was the 
total absence of any medical examination to prove the 
recent defloration of the plaintiff It really appears to us 
unaccountable how such a grave charge could have been 
for a moment entertained by the court and jury against a 
man of unsullied character, in the absence of this most im- 



RAPE ON ADULTS ANAESTHESIA. 525 

portant link in the chain of evidence. We must suppose it to 
have been one of those instances mentioned by Sir Matthew 
Hale, "wherein the court and jury may, with so much ease, 
be imposed upon without great care and vigilance, the 
heinousness of the offence many times transporting the judge 
and jury with so much indignation that they are over-hastily 
carried on to the conviction of the persons accused thereof, 
by the confident testimony of sometimes false and malicious 
witnesses." 

The important medico-legal point to settle in the above 
and similar cases is, whether an individual, under the influ- 
ence of anaesthesia, has such complete control over the 
mental faculties as to fully recognize and appreciate what is 
transpiring around her, and afterwards to minutely describe 
all the particulars, and yet, at the same time, lose the power 
of resistance ? Such an abolition of the will as to destroy 
all power of resistance, implies a narcotism so complete as 
to produce complete unconsciousness. Nothing is more 
certain than that, in such a person, the sense of external 
impressions becomes, at first, very confused, and very soon 
is entirely obliterated. The most painful operations seem 
to produce no sensation whatever. As to the perceptions , 
they soon become perverted ; the person passes rapidly into 
dreamland, " the imvard perceptions of the mind being some- 
times of the most agreeable, and at others, of the most pain- 
ful character; and these dreams may, or may not, be pertinent 
to the actual position of the patient." 

But it is especially upon the emotions that the effects of 
etherization are most conspicuous ; some exhibit signs of 
irrepressible mirth, while others appear weighed down by 
despondency, or excited to violent anger. Women are 
especially liable to be thus affected ; and in some, the erotic 
feelings are unquestionably excited to a high degree. We 



526 MEDICAL JURISPRUDENCE. 

have frequently witnessed this ourselves in female patients, 
and the fact is abundantly corroborated by others. The 
case just alluded to was of a character precisely suited to 
illustrate this point. The young lady was betrothed in 
marriage ; she was accompanied by her lover in her walk 
to the dentist's ; she was just at her menstrual period. What 
more natural, under such circumstances, and when her 
senses were *' stolen away" by the anaesthetic, than that her 
dreams or false perceptions should take the direction which 
should give rise to erotic emotions and sensations ? That 
this is not mere speculation is shown by well attested facts. 
M. Dubois relates a case under his own observation, where 
a woman undergoing an operation, under the influence of 
ether, drew an attendant toward her to kiss, as she was 
lapsing into insensibility; and she afterwards confessed to 
dreaming of coitus with her husband while she lay ether- 
ized. Another case closely resembling the one now under 
consideration, occurred in Montreal, in 1858. A dentist 
was indicted for attempting to commit a rape upon one of 
his patients under the influence of chloroform. At the trial, 
a witness testified that his wife was under the strongest 
impressions that she had been violated by the prisoner 
while under the influence of chloroform ; yet this was a pure 
hallucination, since her husband was present during the 
whole time she was unconscious. 

We are, therefore, of the opinion that in cases similar to 
the above, extreme caution should be exercised in receiving 
the testimony of a prosecutrix who was under the anaesthetic 
influence of ether or chloroform, unless her statement is cor- 
roborated by a proper medical examination. If this is de- 
clined, no matter for what reason, the refusal should be 
regarded as a strong presumption against the validity of the 
charge. 



RAPE ON ADULTS MEDICAL PROOFS. 527 

Medical evidences of rape on adtdts. — In the majority of 
these cases, the examination is postponed so long as to 
afford very few satisfactory data to the physician, since all 
traces of violence, in adults, may disappear in a few days. 
If much resistance has been offered, there will generally be 
found bruises upon the thighs and legs, and possibly upon 
the arms and trunk ; but these are inconclusive of rape, 
without the presence of marks of violence upon the 
pudendum. Besides, they may be produced by the woman 
herself, in order to substantiate a false accusation. In chil- 
dren, for obvious reasons, these marks of violence do not 
occur. The truly important medical signs are derived (i) 
from the condition of the hymen, and of the sexual organs, 
and (2) from the presence of seminal, and blood stains. But 
it should be remembered that these physical marks of rape 
about the genital organs may be found, whether the connec- 
tion has been voluntary, or involuntary. Thus, rupture of 
the hymen, laceration of the vagina, swelling and soreness 
of the organs, effusion and coagula of blood, stains of 
semen and blood upon the person and clothing, may be 
met with in both cases. 

Another circumstance to be recollected is, that girls and 
young women are liable to a muco-purulent discharge aris- 
ing from vaginitis^ somewhat similar to that already noticed 
as found in young children under bad hygienic conditions. 
Older women are liable to leticorrhcea, which may sometimes 
be accompanied with an ulcerated state of the vagina, and 
general soreness and swelling of the parts. It is possible 
that a woman thus affected might bring a false charge of 
rape against an innocent man, alleging that her present 
condition was the result of a rape. Although an ordinary 
leucorrhoea can readily be distinguished from a gonorrhoea, 
the discharge of the latter being purulent, while it is mucous 



528 MEDICAL JURISPRUDENCE. 

in the former, yet a purulent discharge may take place from 
the vagina, as the result of an intense vaginitis, quite inde- 
pendently of sexual intercourse; and such a discharge 
cannot be distinguished from that of gonorrhoea. Dr. 
Taylor very properly remarks that " such discharges, com- 
mencing before, but continuing, and sometimes becoming 
aggravated after, marriage, have given rise to unfounded 
suspicions of infection from venereal disease imparted by 
the husband, and have thus led to suits for divorce." 

I. Condition of the hymen. — Virgi^tity. — Much has been 
said about the unruptured condition of the hymen being 
accepted as a proof of chastity or of virginity, and unques- 
tionably, in the great majority of cases, this is true ; but it 
cannot be affirmed absolutely, and without exception, inas- 
much as numerous authentic instances are recorded where 
the hymen has been destroyed, either by accident, disease, 
self-abuse, or by a surgical operation, to allow the escape 
of the menses ; and, on the other hand, where sexual inter- 
course has been continued for years with the hymen un- 
ruptured, and where even pregnancy had resulted, and it 
became necessary to divide the membrane with a knife before 
delivery could be accomplished. 

In the exceptional cases just alluded to, of the persist- 
ence of the hymen after repeated intercourse, this anomaly 
may be ascribed, according to high authorities, to an abnor- 
mally firm, hard, and resisting structure of the membrane, 
due to the presence of a fibrous, or fibro-elastic tissue. It 
therefore must follow, from all the above facts, that the loss 
of the hymen is not an infallible proof of a loss of chastity ; 
nor does the existence of a hymen constitute an absolute 
evidence of its presence. Casper, however, considers " that 
where a forensic physician finds a hymen still preserved, 
even its edges not being torn, and along with it (in young 



RAPE ON ADULTS SEMINAL STAINS. 529 

persons) a virgin condition of the breasts and external geni- 
tals, he is then justified in giving a positive opinion as to 
the existence of virginity, and vice versa!' 

The other external evidences connected with the sexual 
organs, such as swelling and soreness of the vulva, the 
presence of effused blood, and of seminal stains, would all 
afford strong corroborative proof of rape, provided, want of 
consent could be satisfactorily shown, and an early exami- 
nation be made. 

2. Blood and seminal staiiis. — These may be found upon 
the persons and clothing of both the ravisher and his 
victim. If the garments are tolerably clean, there should 
be no difficulty in recognizing these spots ; but, as they are 
frequently presented for examination, they are in such a 
filthy condition as to render their identification very diffi- 
cult. Moreover, a mistake may arise from the woman's 
garments being intentionally soiled with blood, in cases of 
false accusation. 

The manner of examining blood stains has already been 
explained {ind. ante^ p. 121). 

Examination of seminal spots.— T\vq?>^ stains cause a 
stiffening of the fabric, like those produced by albumen or 
gum. The seminal stain may be identified (i) by gently 
warming it before the fire, when it will assume a pale yellow 
color. (2) If moistened with warm water, it will emit the 
seminal odor. (3) Cut out the suspected stain, and place it 
in a watch glass, adding a few drops of pure water and 
gently squeezing it with a glass rod until thoroughly 
soaked; remove the fragment, and add a drop of nitric acid 
on a glass rod, when the liquid, if seminal, will turn a 
yellow color, without giving a precipitate. (4) Microscopic 
test. — This is the only positive and reliable proof Cut out 
a fragment containing the stain, and treat it as above 



530 MEDICAL JURISPRUDENCE. 

described, with distilled water. After sufficient soaking, 
apply a drop of the liquid to a glass slide and place it under 
the microscope, using a very high power. 

The spermatozoa or zoosperms have a very characteristic 
appearance. They vary considerably both in numbers and 
size. On an average, the human spermatozoa is about the 
^^0 of an inch in length, having a flattened, ovoid head, 
which is about one-third the diameter of the human blood 
corpuscle. Attached to this head is a thread-like, tapering 
tail, that is eight to ten times longer than the head. Very 
often, in old seminal stains, the spermatozoa will be found 
only In a fragmentary state, and the examiner should be 
cautioned not to confound these with fibrillse and other 
bodies which might be accidentally present. The absence 
of these zoosperms is not to be regarded as conclusive that 
the spot is not seminal, since, as Casper and others have 
shown, the seminal fluid does not ahvays contain these 
bodies ; they may be absent in certain debilitating diseases, 
after excessive venery, and in very aged men. 

These bodies exist in the semen of all animals capable of 
procreation, and they are found in man from the age of 
puberty to a very advanced period of life. 

It is possible to tc\\?X2^<.^ fragments of the spermatozoa for 
fibrils of linen and other fabrics washed out at the time of 
the examination. A proper degree of caution, together with 
a knowledge of the peculiar microscopic appearance of these 
fibrils, should prevent this mistake. Hence, we deem it to 
be safest, in such an investigation, not to decide upon the 
seminal character of the stain unless one or more complete 
zoosperms are found. 

M. Donne discovered and described in vaginal mucus, 
where cleanliness is not observed, another animalcule, 
named by him TricJiomonas vagince. These differ from the 



RAPE ON THE DEAD. 531 

true spermatozoa in having the head three times as large 
as that of the latter ; it is also granular, and armed with a 
row of four to six ciliae. 

The spermatozoa appear to retain life long after the death 
of the body. Prof Hoffmann, of Vienna, observed active 
movements in them from eighty to one hundred hours after 
death. In the dried state, they may be identified years 
afterwards. 

In some cases of alleged rape it may be necessary to 
examine the vaginal secretion for evidence of recent inter- 
course. If this has occurred, the presence of the sperma- 
tozoa may easily be discovered by placing a drop of the 
mucus upon a glass slide and subjecting it to microscopic 
examination for the zoosperms. It has been shown by 
Mialler that the spermatozoa will retain life and activity for 
eight days, in the vaginal mucus. 

Evidence of 7'ape on the dead, — The legal physician is 
sometimes required to determine the fact of violation in a 
dead female, where a murder has been committed. The 
difficulty here is, of course, increased by the absence of evi- 
dence from the prosecutrix herself The proofs of violation 
in the case of a very young girl would be easily made out, 
but in the case of an adult, even if the evidence of rupture 
of the hymen and vulval swelling and effused blood pointed 
to a recent defloration, this would not prove the want of 
consent on her part. If, however, there existed at the same 
time other marks of extreme violence upon the body, this 
would be strong circumstantial evidence that the outrage 
had been perpetrated before the murder. 

Rape of females on males. — This unnatural crime is very 
rarely brought before the courts, although several instances 
are related in the books of females enticing young boys to 
its commission. The only medical proof of it would be the 



532 MEDICAL JURISPRUDENCE. 

transmission of gonorrhoea or syphilis from the woman to 
the child. 

Unnatural Crimes. — Sodomy, Pederastia. — Bestiality. — 
Sodomy, or Pederastia, is the unnatural intercourse of man 
with man. Bestiality implies unnatural intercourse with 
animals. Both acts are criminal, and are regarded by the 
law as felonious, and are punished in England by penal 
servitude, and in this country by imprisonment for a term 
of years. 

In the case of sodomy^ both the parties are held to be 
equally guilty, unless it can be shown that the patient was 
not consenting, was under age, was unconscious at the time, 
or was idiotic or insane. The facts of this crime are usually 
proved without medical evidence, except in the case of 
young persons, when marks of physical violence will usually 
be sufficiently apparent. Collateral proof would be given 
by the discovery of seminal stains upon the person or linen. 

Unless the examination be made soon after the perpetra- 
tion of the act, all evidence of it will have disappeared, just 
as in cases of rape. In the habitues of this unnatural vice, 
according to Casper and Tardieu, there are, certain altera- 
tions of the parts that may be regarded as characteristic, 
such as a funnel-shaped condition of the anus, which is 
enlarged, smooth, and even patulous, the folds, or ruga^, 
having disappeared. There may also be other marks 
around the anus, such as cicatrices, chancres, and venereal 
warts. In recent cases, laceration of the sphincter ani, 
fissures, and bruises, with effusion of blood, might all be 
observed. 

Legal relations of Rape. — The crime is not excused if the 
woman has submitted : — 

(i) From stupefaction, produced either by disease (coma), 
or by drugs — including alcohol, chloroform, and ether. 



RAPE LEGAL RELATIONS. 633 

Although, in such cases, the violation, strictly speaking, be 
not against her will, it is without her will, which is regarded 
as the same thing. And this is true, even if it can be shown 
that the drug was administered for the purpose merely of 
exciting, and not stupefying. But it is vastly important that 
the distinction should be clearly drawn between the erotic 
sensations and perverted impressions of a female while 
under an anaesthetic influence for professional purposes (as 
a surgical or dental operation), and who may subsequently 
institute a false accusation, and similar sensations resulting 
from the criminal administration of chloroform or ether, 
and where the will or resisting power appears to be taken 
away from the subject, even before the anaesthesia is com- 
plete. 

(2) From ignorance of the nature of the act. — Such in- 
stances occur in young children, and in older women who 
are idiotic or insane. In some recent cases, both in this 
country and in England, it has been held that, in dementia 
not amounting to positive idiocy, if consent were given, 
and no compulsory force employed, it did not constitute 
rape. 

(3) From mistake of person. — As where a married woman 
was raped in her sleep, and awoke supposing she was em- 
braced by her husband. Of course, all such cases require 
to be carefully sifted. 

(4) From fear. — Submission extorted through fear of 
death, or violent threatening, is no excuse for the act. 

(5) From prior want of character of the prosecutrix. — Prior 
want of character in the woman is no ground of excuse for 
the crime, if it was perpetrated by force, and against her 
will ; not even if she were a common prostitute, or the 
mistress of the defendant. But the proof of an unchaste 
character in the prosecutrix would be likely to go far in 



534 MEDICAL JURISPRUDENCE. 

nullifying a charge of rape, since it would render the fact 
of force less likely, and it would also tend to lessen the 
credibility of the witness. The allegation of unchastity in 
the woman could further be supported by a medical exami- 
nation, which might reveal the existence of syphilis or 
gonorrhoea. But it should be remembered that this exami- 
nation is not compulsory; the woman is not obliged to 
convict herself. 

(6) Subsequent suppression of iJie fact by the prosecutrix. — 
If the alleged violation be suppressed by the woman for 
such a length of time as to prevent any evidence being 
obtained by a medical examination, this will (or ought to) 
go very far in lessening the credibility of her testimony. 
Not a few instances of this character have turned out to be 
cases of false accusation. 

(7) Want of age^ and of sexual capacity of the defendant. — 
According to the law, an infant under fourteen years is pre- 
sumed to be incapable of committing a rape, though he 
may be convicted of an assault, with intent to ravish. The 
want of sexual capacity is purely a m.edical question to be 
determined at the time. 



INSANITY. 635 



CHAPTER XXXVIII. 

INSANITY. 
SECTION I. 

MEDICO-LEGAL DIFFICULTIES OF INSANITY. — CIVIL AND CRIMINAL 
RESPONSIBILITY. — LEGAL TERMS. — ILLUSIONS, HALLUCINATIONS, 
DELUSIONS. — CONCEALMENT OF THEIR DELUSIONS BY THE INSANE. 
— LUCID INTERVALS. — CLASSIFICATION. 

In a work like the present, it would be impossible to enter 
into a full discussion of the subject of Insanity. For this, 
the reader must be referred to the many admirable treatises 
now accessible, both in the English and foreign languages. 
All that we can expect to accomplish is to present the sub- 
ject under certain particular phases, with a special reference 
to its medico-legal relations, so as to enable the student of 
legal medicine to properly understand his true professional 
position in reference to that class of persons who have been 
unhappily deprived of reason, — how to determine, first of 
all, the fact of their insanity, and secondly its degree, as 
involving the all-important question of their civil and 
criminal responsibility. 

The legal physician may encounter considerable difficul- 
ties in cases of real, or alleged insanity. In the first place, 
there is the difficulty, if not the actual impossibility, of de- 
termining the precise boundary between mental health and 
mental disease, just as it is often impossible to do in the 
case of bodily health and bodily disease. Even in respect 
to the individual mental powers or faculties, the greatest 
variation is observed. Rarely do we find in society a 
specimen of a perfectly normal and harmonious adjustment 



536 MEDICAL JURISPRUDENCE. 

of all the powers of the mind. Scarcely ever is a person 
discovered, in whom no one of the mental faculties is 
allowed to exert an undue preponderance over the others. 
" On the one hand, for instance, individuals are observed, 
who possess, along with a wondrous power of memory, just 
as feeble a power of judgment; while others, to the most 
vivid powers of imagination, conjoin a most wretchedly 
deficient power of will. In one, an excessive vivacity of 
character may betray its possessor into actions which may 
raise doubts as to his actual sanity ; whilst in another, 
originality of character flashing out as true genius, may so 
stamp its peculiarities on every act, as to require a sharp 
observation if the limits of sanity have not been over- 
stepped" (Casper). 

Another great difficulty in coming to a decision in the 
matter arises from the impossibility, often, of discovering the 
motives of any action, even the most extraordinary. WWlst 
the absence of all rational motive may usually be regarded 
as indicative of an insane act, we must not be too ready to 
admit this absence in any particular case, since these 
motives, as Casper justly remarks, " maybe so deeply buried 
in the soul of the agent as frequently to baffle the greatest 
experience in arriving at a logical conclusion." The sub- 
ject of 7notive in the acts of the insane will be noticed 
further on. 

Still another difficulty in the diagnosis of an alleged 
mental disorder is presented by the possibility, on the one 
hand, of its being feigned, and on the other, of the real 
disease being concealed by the subject with the most con- 
summate art. 

All the medico-legal questions arising, out of insanity are 
comprehended under the twofold inquiry : first, as to the 
civil responsibility of the individual, and secondly, as to his 



INSANITY LEGAL TERMS. 537 

criminal responsibility. These two points cover the whole 
ground of a medico-legal investigation in every case of real, 
or suspected insanity. 

By civil responsibility is understood the capability of 
managing the ordinary affairs of civil life, such as the enter- 
ing into contracts, the making of a will, the performing the 
functions of a public officer, or in common-law phrase, " the 
managing his own affairs." 

Criminal responsibility has reference solely to criminal acts, 
and involves the inquiry whether an individual committing 
some particular crime, such as murder, theft, or arson, was 
in such a healthy state of mind at the time of the commis- 
sion of the deed, as to render him a responsible agent? 

One other point we would briefly suggest : every human 
being of responsible age and sound mind is conscious of 
possessing the power of will, or of moral freedom, — of 
choosing between good and evil ; and, although, in conse- 
quence of faulty training, bad associations, and the power of 
temptation, he may " choose the evil," yet he is fully 
responsible for this choice and all its consequences, provided 
he possessed, at the time, a healthy mind. 

Legal terms. — Before entering upon a farther discus- 
sion of the subject, it will be proper clearly to define certain 
terms used in the law, in connection with insanity, in order 
that the medical witness may ^\y^ intelligent answers to the 
questions propounded to him when on the stand. And 
here we would again interpose a word of caution to the 
witness, to confine his answers strictly to the questions put 
to him, and to speak of insanity only as a disease, avoiding 
the tendency to theorize, or speculate upon legal distinctions. 

Illusions are false mental impressions derived through the 
senses. Real things are distorted. A timid person, for 
24 



538 MEDICAL JURISPRUDENCE. 

instance, may mistake, in the dark, a post or a shrub for a 
man ; or the drapery of his bed curtains, in the moonHght, 
may be distorted into an apprehended ghost. The tricks of 
the juggler and clairvoyant are illustrations of this sort of 
illusion. Sometimes, the false impression is entirely mejital, 
reproduced by the memory, or by a strong effort of the will, 
recalling the scenes of past pleasures or sorrows, the 
features and persons of friends, and even the tones of their 
voices and other sounds. Such mental images, denomi- 
nated by Dr. Rush waking dreams^ are called spectral illu- 
sions, or phantasms, when they have reference to the sense 
of sight, although the actual vision of the individual may, 
at the time, be defective, since they occur equally to the 
blind. 

The distinctive characteristic of an illusion is that the 
false perception can be soon corrected by an appeal to the 
other senses, or to the judgment. If, however, it is persist- 
ently believed to have a positive existence, and this belief is 
not removed either by reflection, or by a reference to the 
other senses, then the illusion becomes a delusion, or a mis- 
leading of the mind, and it indicates a disordered mind. 

Hallucinations are also perverted perceptions, but without 
material bases. The false impressions are usually conveyed 
through the organs of hearing. If the individual is able to 
correct them by his judgment, or by reference to his other 
senses, they are of no significance ; but if they are firmly 
believed in, they indicate a deranged mental condition. If 
the person fancies he hears strange voices, constantly urging 
him on to the commission of some horrible crime, or sees 
purely imaginary personages, these are among the surest 
indications of insanity. 

Some writers make no distinction between hallucinations 
and illusions, whilst others, and we think very properly. 



INSANITY DELUSIONS. 539 

regard them as differing in this : an hallucination is an 
unreal sensation, wholly due to the action of the brain; an 
illusion is a real sensation — that is, is produced by some 
real object, although distorted. Nicolai, the Berlin book- 
seller, was for years troubled with seeing unreal objects 
(spectral illusions), and sometimes by hearing unreal sounds 
(hallucinations), but he did not believe in them ; hence they 
never became delusions in his case. 

A delusion is a belief in something purely imaginary, and 
which has no real existence, and where this belief cannot 
be corrected by the judgment, nor when confronted with 
contradictory proof, as, ^. ^., when a man imagines himself 
made of glass, and is afraid to suffer any one to approach 
him, lest he be broken to pieces ; or where a pauper fancies 
himself suddenly to have become a millionaire, or a king ; 
or where a rich man imagines himself to have been reduced 
to beggary, etc. All such delusions are clear manifesta- 
tions of mental disturbance. In legal matters, however, the 
question of responsibility (whether civil or criminal) depends 
upon the connection of the act with the particular delusion. 
For example, if the delusion is such as to prevent the 
individual from exerting a " rational act of volition," in 
the matter of disposing of his property by will — as when, 
through disease, he may have come to entertain a bitter 
hatred for those entitled to his love and gratitude — then he 
does not possess testainenta^y capacity, and is, so far, of 
unsound mind. But if the delusion be upon a subject 
entirely disconnected with the act (as is seen in some mono- 
maniacs), then the responsibility of the individual is not 
necessarily affected. 

The existence of the most extraordinary delusions for 
years, in an individual, is quite consistent with an otherwise 
apparently sound mental condition. We know of a highly- 



540 MEDICAL JURISPRUDENCE. 

educated lady, an artist of considerable abilities, who enter- 
tains the delusion that she is, in some mysterious manner, 
incorporated with the Holy Trinity, and that she receives 
direct communications from the Father, which require her 
to give up all her church relations, and her former very 
strict orthodox creed. Yet this lady goes out into society, 
converses intelligently upon ordinary subjects, and passes 
generally for a sensible woman. 

The cunning of the insane in concealing their delusions 
is often quite remarkable. Every superintendent of an 
asylum has had experience of it in patients under his obser- 
vation. Perhaps the best illustrations are afforded in cases 
where patients, who wish to escape from an asylum, are 
brought into court, under writ of habeas corpus, for their 
discharge, and where they so skillfully and adroitly pass 
their examination, as often to deceive both court and 
jury. 

The two oft-quoted instances of the above may bear 
repetition here. The late Lord Erskine was engaged in a 
case in which a lunatic had brought an action against his 
brother and the keeper of the asylum, for false imprison- 
ment. The man was closely interrogated by the learned 
lord for nearly the whole day, without his being able to 
elicit anything to prove his delusions, when a gentleman 
came into court, and suggested to the learned counsel that 
the patient believed himself to be the Saviour, Jesus Christ. 
Lord Erskine immediately acted upon the hint, and addressed 
the man with a profound reverence, suitable to his assumed 
character, and apologizing for his former want of respect. 
The patient at once expressed his forgiveness, and, with the 
utmost gravity, in the face of the whole court, said, " yes, I 
am the Christ." 

In the other case, tried before Lord Mansfield, the patient 



INSANITY LUCID INTERVALS. 541 

evaded the questions of the court the whole day, till his 
physician arriving, asked him what had become of the prin- 
cess with whom he corresponded in cherry juice ? Instantly 
the man forgot himself, the true spring had been touched, 
and he replied, saying it was true he had been confined in 
a castle, where, for want of pen and ink, he had written his 
letters in cherry-juice, and thrown them into the stream 
below, and that the princess had received them in a boat. 
Such answers, of course, immediately terminated these 
cases. 

Lucid intervals. — In a legal sense, the term lucid interval 
means a temporary intermission of the insanity, during 
which the reasoning power is recovered. It differs from a 
mere remission of the symptoms, such as is seen in some 
cases of violent mania. During such an interval, the law 
recognizes the power of the individual to make a will, to 
sign a contract, or exercise his civil rights. He is also held 
responsible for crimes committed during such a period. 
The duration of these intervals is uncertain, varying from a 
few minutes, to weeks, or months. If the interval is very 
short, the fact of its alleged existence is always the more 
questionable. In case of a crime committed in a '' lucid 
interval," especially if this be of short duration, there is 
usually an indisposition to convict on the part of a jury, if 
it can be clearly proved that the person was really insane 
within a short period of the time of its perpetration. 

Lucid intervals are most common in mania and mono- 
mania ; they also occasionally occur in dementia, when not 
chronic. They are never met with in idiocy and imbecility. 

In order to establish the fact of the existence of a lucid 
interval, the burden of proof rests upon the plaintiff, in a 
suit in which he desires to prove the validity of a contract 
made by the lunatic during such an interval. 



542 



MEDICAL JURISPRUDENCE. 



Varieties and Classification of Insanity. — Medical 
jurists usually recognize four distinct varieties or forms of 
insanity: (i) Idiocy {amentia); (2) Mania; (3) Monoma- 
nia ; (4) Dementia (Esquirol). 

The classification of Dr. Ray is, for the most part, 
followed here, as being convenient and sufficiently practical 
for medico-legal purposes. 



Defective devel- 
opment of the 
faculties. 
(Amentia). 



II. 

Lesion of the 
faculties subse- 
quent to their 

development. 



Idiocy. — Resulting from congenital defect. 



Imbecility. -! 



Resulting in infancy, from arrest in the development 
of the faculties. 



Mania 
(of Ray). 



Intellectual, af- 
fecting the intel- 
lect. 



r Mania of authors, ex- 
citation of the facul- 
General. \ ties. 

Melancholia, depres- 
1^ sion of the faculties. 
Partial. — Monomania. 



Moral, affecting I General, 
the will. (Partial. 



Dementia. 



TMonomonia, or par- 
\ tial affection of the 
■* (_ moral faculties. 

1. Consecutive to mania, or to injuries of the brain. 

2. Senile, peculiar to old age. 



SECTION II. 
I. DEFECTIVE DEVELOPMENT OF THE FACULTIES (Amentia), 



IDIOCY, PHYSICAL MARKS OF. PATHOLOGICAL MARKS. — IMBECILITY 

DIFFERS FROM IDIOCY. — CRETINISM. — LEGAL RELATIONS OF IDIOCY 
AND IMBECILITY. 

Idiocy is distinguished from all other forms of mental 
disorder by being congenital ; and this condition is mani- 
fested by imperfect development of both body and mind. 
The idiot, from an original defective structure of the brain, 
is never able to acquire any, or only the most limited, 
degree of intellectual power. His instincts, habits and 
appetites are purely animal. Often there is no sign of 
recognition, nor indication of memory, in which respect he 
is below the intelligent animals. There are some cases of 
idiocy, however, where the want of cerebral development is 



INSANITY PECULIARITIES OF IDIOTS. 543 

not quite so extreme, and where some glimmering of intelli- 
gence is manifested, through a very partial development of 
some few of the faculties. Such idiots are docile and tract- 
able; they are capable of being taught many things by 
careful and judicious training, even to talk and read ; and 
thus of being materially elevated above their former level. 
These latter instances should, probably, for the sake of pre- 
cision in language, be described as imbeciles, rather than 
idiots, reserving the latter term for those whose minds are 
a complete blank. 

The chief causes of idiocy are referable to intemperance 
m the parents, and marriages of consanguinity. Syphilis 
has also been supposed to predispose to idiocy m the off- 
spring. Idiots are generally short-lived, their age rarely 
extending beyond thirty years. 

Physical peculiarities of idiots. — These are manifested in 
smallness of the head, in the majority; thickness of the 
lips, which are often fissured, particularly the lower one ; 
enlargement of the tongue, salivary glands, and tonsils ; 
vaulting of the hard palate; irregularity of the teeth, with 
tendency to early decay; deficiency of the lobules of the 
ears ; defects of vision, such as myopia and congenital cata- 
ract ; weakness and clubbed appearance of the fingers and 
thumbs, and want of power over the sphincters. In some 
idiots, the head is preternatu rally large, especially in con- 
genital hydrocephalus. 

An autopsy will generally disclose a deficiency of gray 
matter (from a defective size of the brain) and a want of 
proper development of the convolutions ; sometimes an 
absence of the entire cerebellum, of the pineal gland, of 
part of the fornix, of the olivary bodies, thalamus, and 
corpus striatum ; and an absence, or rudimentary state, of 
corpus callosum, and soft commissures. D^af-dumbness is 



544 MEDICAL JURISPRUDENCE. 

common. Some are born deaf, dumb and blind; yet, in the 
case of Laura Bridgman, the deprivation of all these faculties 
did not hinder a remarkable degree of intelligence, under a 
careful training. 

Whilst the higher faculties are wanting, there often exists 
a marked development of the lower ones, such as the love 
of money, the sexual feeling, gluttony, and filthy habits, 
together with a slow and tottering gait. 

Cretinism. — A peculiar form of idiocy, at one time sup- 
posed to be endemic in certain mountainous countries, as 
Switzerland, Savoy, etc. It is chiefly marked by an enor- 
mous development of the thyroid gland, which, however, in 
some cases, may be altogether absent. The mouth is large, 
snd the hands and fingers misshapen. The eyes are squint- 
ing, the face pale and sallow, and the speech thick and 
muffled. The intelligence is about that of idiocy. The 
smaller ^(^//rf J found in other countries do not necessarily 
impair the intellect. 

Imbecility. — This differs from idiocy chiefly from the 
fact of its being acquired after birth ; the bodily defects are 
also asymmetrical, and the intellectual manifestations are 
rather different, being exhibited in low, mischievous cun- 
ning, bad temper, silliness and stupidity, and may often be 
accompanied with epilepsy or paralysis (Hamilton). The 
power of speech is less frequently absent than in idiocy. 

The precise boundary between idiocy and imbecility can- 
not be defined so far as intellectual manifestations are con- 
cerned, unless we make the distinction to consist in the 
congenital character of the former. Neither of them is 
likely to be confounded with mania and monomania, since, 
in the former, there is a total absence of ideas and of the 



INSANITY MANIA. 545 

power of thought, both of which are present in maniacs and 
monomaniacs, although perverted and irregular. Moreover, 
idiocy and imbecility are destitute of hallucinations, which 
are characteristic of mania and monomania. Their resem- 
blance to confirmed dementia is much stronger. 

Legal relations of Idiocy and Imbecility. — When these 
mental conditions are positive and distinct, there can be no 
question of their entire irresponsibility, both civil and 
criminal. 

SECTION III. 

II. LESION OF THE MENTAL FACULTIES SUBSEQUENT TO 
THEIR DEVELOPMENT. 

GENERAL INTELLECTUAL MANIA. — CHARACTERISTIC SYMPTOMS. — 
MELANCHOLIA. — SYMPTOMS. — PARTIAL INTELLECTUAL MANIA. — 
MORAL MANIA OF RAY. — PARTIAL MORAL MANIA. — MONOMANIA. — 
KLEPTOMANIA. — PYROMANIA. — DIPSOMANIA. — RESPONSIBILITY OF 
DRUNKARDS. — SOMNAMBULISM. 

General Intellectual Mania. — This division, according to 
some writers, includes Mania proper, and Melancholia. We 
shall consider them separately. 

Mania. — This variety of mental disorder is characterized 
by a general perversion of the mental faculties, accompanied 
by more or less excitement, sometimes amounting to fury. 
The reasoning faculty is not absolutely lost, but disturbed 
and confused ; ideas flow through the mind without order 
or connection ; they are evolved from the brain in chaotic 
exuberance, following one another with inconceivable 
rapidity, and entirely without control. With the maniac, 
everything is active — the emotions, the memory, the 
imagination, the speech, and the features. " He mingles 
abusive, obscene and blasphemous words with the most 
pious reflections." His movements are brusque, disorderly 
24* 



546 MEDICAL JURISPRUDENCE. 

and extravagant; he dances, runs, leaps, tears off his 
clothes, breaks things, and exhibits enormous strength. 
The voice becomes hoarse, the skin is dry and hot ; the eye 
has a peculiar, wild, brilliant expression, with often a fixed 
stare. The pulse is rapid, and respiration and temperatare 
above normal. They generally eat enormously and vora- 
ciously. Urine and faeces are often passed involuntarily ; 
the bowels are apt to be torpid ; perspiration abundant and 
sour. There is frequently sexual excitement, particularly 
in females, and when this is the chief feature of the mental 
disturbance, it receives the name of nymphomania^ or more 
generically, erotomania, which also includes satyriasis in 
men. 

Along with the intellectual, the moral faculties become 
more or less perverted, and the patient's social and domestic 
relations are greatly altered, jealousy, suspicion and hatred 
being evinced toward those whom he had formerly loved 
with the deepest affection. He is haunted by the wildest 
delusions, under whose influence he may act in the most 
dangerous and ungovernable manner. 

Melancholia. — This second division of General Intel- 
lectual Mania differs materially from the first (mania proper), 
in being connected with depression, instead of excitement. 
Delusions may not always be present, or, at least, not be 
observable ; the sufferer is gloomy, and the prey to unhappy 
and desponding thoughts, which often lead to suicide ; he 
is sleepless ; refuses food, often under the delusion that it is 
poisoned. The delusions and hallucinations may assume 
an infinite variety of shapes ; they are often of a religious 
character, and very frequently connected with an idea of 
undergoing persecution. This latter delusion is very com- 
mon, and under its influence the sufferer may resort to 



INSANITY MORAL MANIA. 547 

homicidal violence toward those who, he may imagine, are 
his enemies. He should, therefore, be constantly watched. 

This form of mental disorder rarely exists in an uncom- 
plicated form ; it is apt to be alternated with fits of excite- 
ment (mania). The physical characters of melancholia are 
quite characteristic. " The patient, if a female, is dirty in her 
habits, soiling her clothes, and paying little attention to her 
appearance. With disordered hair, and averted eyes, the 
melancholic sits by herself, lost in her own reflections, 
although there are some who are communicative and loqua- 
cious." " The face is pinched and wan, and unnaturally pale ; 
the eyelids droop, and the facial folds are dependent ; the lips 
are bloodless ; the pupils are dilated, and everything indi- 
cates inaction ; the hands are livid, and hang idly, and the 
maintenance of a fixed position, sometimes for hours at a 
time, is characteristic of the intellectual torpor " (Hamilton). 

Partial Intellectual Mania. — This variety of mental dis- 
order, as well as that classed under the head of Partial 
Moral Insanity, may be considered as including the " Mono- 
mania " of Esquirol. " The patient, in the simplest form of 
the disease, becomes possessed of some single notion, which 
is alike contradictory to common sense and to his own 
experience " (Husband). Sometimes it may have reference 
to some fancied bodily disease, as where he believes he has 
a snake, or a lizard in his stomach; or, like the case of 
the woman mentioned by Esquirol, who had hydatids in the 
uterus, and who believed that she was pregnant by the 
devil. Other illustrations of Monomania will be given 
under the succeeding head. 

Moral Mania. — This title has been assigned, by Dr. Ray 
and others, to those cases of mental disturbance which, in 
the language of Prichard, " consist in a morbid perversion 



548 MEDICAL JURISPRUDENCE. 

of the natural feelings, affections, inclinations, temper, habits, 
and moral dispositions, without any notable lesion of the 
intellect, or knowing or reasoning faculties, and particularly 
without any maniacal hallucinations." There is consider- 
able diversity of opinion among writers, as to the existence 
of moral insanity as a distinct variety of mental disorder. 
Some deny its existence as such, and assert that there can 
be no derangement of the mind, without the intellect being 
affected. Such authorities are disposed to regard the 
merely moral perversions above alluded to as evidences 
of a moral obliquity, showing an excessive perverse- 
ness of character, rather than a derangement of mind. 
What has been termed emotional insanity, in modern times, 
partakes of this character. It has become quite too much 
the fashion, in our times, to excuse, or palliate many atro- 
cious crimes (even murder), by attributing them to a sudden 
outbreak of emotional insanity. We must regard this as a 
most dangerous and unsafe doctrine. It may be affirmed, 
with certainty, that no person becomes suddenly affected, /<?r 
the first time, with an insane, homicidal impulse ; and we are 
of the opinion that, unless it can be clearly shown that the 
culprit had exhibited previous unequivocal signs of insanity, 
such a flimsy plea as that of emotional insanity should not 
be allowed as a bar to punishment. Unquestionably, the 
moral faculties are perverted in insanity, often, to appearance, 
more decidedly than those of the intellect ; but we are slow 
to believe that they are ever exclusively deranged. The 
manifestations of a disordered mind may assume an almost 
endless variety of forms, doubtless dependent somewhat 
on the natural disposition, or mental conformation, of the 
patient. In some, the intellectual perversions will be more 
pronounced ; in others, disturbances of the moral faculties, 
affections and sentiments, are more obvious. Hence, it 



INSANITY KLEPTOMANIA. 549 

would be highly dangerous to pronounce a person insane, 
unless there was some evidence of intellectual disturbance, 
along with exhibitions of a depraved moral nature. 

The law does not recognize moral insanity as an inde- 
pendent state ; " hence, however perverted the affections, 
moral feelings, or sentiments, may be, the medical jurist 
must always look for some indications of disturbed reason " 
(Taylor). Although, according to Dr. Prichard, there are 
two forms of insanity (moral and intellectual), in law there 
is but one — that which affects the mind. 

Partial moral mania (^Monomania). — By this is to be 
understood such cases of mania as are manifested by cer- 
tain forms of moral perversion, when only one or two of 
the moral powers are deranged. Different terms are em- 
ployed to designate these. 

Kleptomania, or a propensity to steal, as shown in persons 
of excellent moral character in other respects, and whose 
easy, and even affluent, circumstances preclude the idea of 
zvant, as a motive inciting to the crime. Some kleptomaniacs 
appear to be sensible of their fault, and are ready to confess 
and lament their unhappy propensity. There are, however, 
cases of so-called kleptomania in which there is a perfect 
consciousness of the act, and of its illegality ; where the 
article stolen, although of trifling value, was yet of some 
use to the person ; where art and precaution were employed 
in the theft ; and where there was, subsequently, a denial of 
the act, or some evasive excuse. Of such persons, it might 
more properly be said, that their organ of secretiveness was 
very largely developed. In a trial of a case of this kind, the 
defence should satisfactorily prove his incapacity of under- 
standing that the particular act in question was a wrong one. 
Otherwise, the whole class of thieves might equally urge 
the plea of insanity as a palliation of their crime. 



550 MEDICAL JURISPRUDKNCE. 

Pyromania, — A propensity, or impulse to set fire to every- 
thing — houses, barns, churches, etc., without any motive. 
Hamilton speaks of it as being often connected with a 
variety of epileptic insanity. It is rare to find this moral 
perversion disconnected with other morbid impulses, espe- 
cially homicidal, or suicidal. A well known historical 
instance of pyromania is that of Martin, who attempted to 
set fire to York cathedral. Doubtless, many cases of so- 
called pyromania would be found, on investigation, to 
originate in personal grudge, or revenge. 

Dipsomania. — Responsibility of Drunkards. — By this term 
is understood that form of insanity which manifests itself in 
a craving for alcohol — a craze for drink. It differs from the 
habitual desire for liquor of the ordinary dram-drinker in 
the fact that there are distinct remissions of the disease, 
during which there is not the slightest longing for drink 
experienced, but rather a loathing of it ; but when this 
interval has passed away, the inordinate desire returns, 
and the unhappy victim will plunge into violent ex- 
cesses, frequenting (as we have known) the lowest taverns, 
and spending days and nights in literally saturating his 
system by drinking enormous quantities of brandy, and 
other spirits. During these excesses, the person shuns 
all society, and remains often secluded for many days, 
and even weeks. 

As regards the responsibility of drunkards, opinions some- 
what differ. There can be no question that, where the mind 
has become completely weakened by habitual drunkenness, 
the law would infer irresponsibility, unless it was clear that, 
at the time of the act, the person was fully aware of its nature 
and criminality. In a case of complete inebriety, where 
there is entire loss of consciousness, the individual is in- 
capable of giving a valid consent, consequently any deed or 



INSANITY SOMNAMBULISM. 551 

contract then executed would be invalid ; but if the intoxi- 
cation be only partial, so that the party knew what he was 
about, the act or deed would be held to be valid. A con- 
fession made by a partially drunken man is legally admis- 
sible as evidence against him, provided it is corroborated by 
circumstances. 

The criminal responsibility of drunkards is more rigidly 
regarded by the law than their civil responsibility. Thus, 
murder committed by a drunken man is not extenuated, 
because his brain may have been crazed by drink, if volun- 
tarily induced on his part. If it can be shown that the 
drunkenness has produced a disease of the mind to such an 
extent as to have deprived him of a consciousness of the 
illegality of the act, then his irresponsibility must be 
admitted. A mitigating circumstance in such a case would 
be, if it could be shown that the prisoner was not actuated 
by malice or grudge against the deceased, but had killed 
him while under the effects of alcoholism. 

Although drunkenness does not excuse crime, in the eye 
of the law, yet the insanity which may result from habitual 
drunkenness does certainly confer irresponsibility. So, 
likewise, it has been decided in some cases of delirium 
tremens, when the brain is temporarily diseased, so as to 
render the individual capable of reason. 

Somnambulism. — The degree of responsibility for acts 
committed in sleep-walking, or somnambulism, is on a 
precise par with those committed in delirium tremens, i. e., 
there is no responsibility. In the " unconscious cerebration" 
during sleep, it is presumed that intention and malice, the 
chief ingredients of crime, are wanting. So, also, in the 
case of a person half awake, suddenly aroused under the 
effect of a delusion of a dream, who may make a murderous 



552 MEDICAL JURISPRUDENCE. 

attack upon his wife or child, supposing he is defending him- 
self against a mortal enemy, no criminal responsibility would 
be imputed to him. 

SECTION IV. 

HOMICIDAL, SUICIDAL AND PUERPERAL MANIA. 

Homicidal Mania (or monomania). — In this form of 
madness, the propensity to homicide is very great. There 
may, or may not accompany it some intellectual aberrations; 
but the characteristic feature is an uncontrollable impulse to 
take life — often of those dearest to the unhappy victim — 
actuated by some delusion, which has, perhaps, been prey- 
ing upon his mind for months before, but only now suddenly 
breaking out. Many striking cases of this form of insanity 
are recorded in the books, all, however, evincing other 
unmistakable signs of intellectual disturbance. 

The following suggestions, taken chiefly from Husband, 
may aid in forming a diagnosis of the existence, or non- 
existence of this form of insanity : — 

1. Inquire into the previous history of the person; was 
he morose, melancholic, apprehensive of impending evil, 
etc. ? Had he previously received a fall upon his head, or 
been otherwise injured? Such a homicidal propensity 
rarely, if ever, manifests itself suddenly for the first time, 
like a flash of lightning out of a clear sky; it is almost 
invariably preceded by other symptoms of mental disturb- 
ance. 

2. Ascertain the presence or absence of motive — a most 
important factor in the responsibility of the accused. Often 
the real motive may be so deeply hidden in the breast of 
the culprit as to be completely concealed from the view of 
others, and scarcely recognized by himself. 

3. A number of victims may be sacrificed at one time by 



INSANITY SUICIDAL MANIA. 653 

the madman ; the murderer, on the other hand, seldom 
sheds more blood than is necessary for his success. 

4. The conduct of the accused before and after the crime ; 
the insane man usually makes no attempt to escape, but 
rather glories in the bloody deed, assigning his conduct to a 
divine, or spiritual impulse. 

5. The character of the victims. Not unfrequently the 
madman destroys those who were the dearest to him while 
he was sane, and for whose destruction he could have had 
no conceivable motive. 

Suicidal Mania (or monomania). — This form of insanity 
displays itself by the prominent idea of self-destruction. 
Considerable diversity of opinion exists upon the question 
whether suicide is always to be regarded as evidence of 
insanity. Our own opinion is that, while in many, probably 
the majority of cases, suicide is to be directly ascribed to 
insanity, there are numerous instances where the act of self- 
destruction is deliberately perpetrated, with a distinct motive, 
and for a purpose. We know from history, ancient and 
modern, sacred and profane, that suicide was formerly 
regarded as rather a praiseworthy act on the part of persons 
wearied of life. Philosophers, poets, statesmen, generals 
and moralists both believed in it, and practiced it. Even at 
the present date, it exists under national sanction in India 
and Japan. Moreover, the laws of most modern civilized 
countries regard suicide as a crime, which they could not 
consistently do, if it was merely the manifestation of disease 
(insanity). Consequently, the argument is unanswerable, 
that many cases of suicide are the result of a perfectly sane 
and deliberate purpose, acting upon the unhappy victim, 
and leading him to prefer death by his own hand, rather than 
endure the miseries of his present existence. 



554 MEDICAL JURISPRUDENCE. 

The almost uniform verdict of coroner's juries in cases 
of suicide — " death by his own hands, while laboring under 
temporary insanity" — would seem to give some weight to 
the popular idea that suicide was always the result of 
insanity ; but this is doubtless to be ascribed to a natural 
desire on their part to soften down as much as possible the 
terrible nature of the death, in consideration of the feelings 
of the surviving relatives. 

In cases of true suicidal mania, it may happen that a 
latent delusion, often assuming the form of hallucination, 
may have been haunting the victim for months before the 
perpetration of the fatal act ; while in other instances, the 
impulse is sudden, and apparently unpremeditated. But 
even in the latter case it will usually be found, on careful 
examination into the previous history of the person, that 
there were some former manifestations of mental disorder. 
The case of the barber (mentioned by Sir C. Bell) who cut 
his own throat immediately after hearing a surgeon, whom 
he was shaving, describe the proper mode of performing 
that deed, illustrates the suddenness of the impulse in some 
cases of suicide ; but we think it is altogether probable that 
the mind of this man had been frequently dwelling upon the 
subject previous to the commission of the deed. 

It is well understood that the law does not regard suicide 
as evidence of insanity, so that the validity of a will 
executed by one who subsequently takes his own life is not 
affected thereby. 

The relation of suicide to life insurance is one of great 
practical importance, in a medico-legal point of view. The 
policies of most life insurance companies contain a clause 
to the effect that said policy becomes void if the insurer 
should " die by his own hand" — making no distinction 
whatever between a felo-de-se committed deliberately, and 



INSANITY — SUICIDE. 655 

intelligently, and a suicide resulting either from the acute 
delirium of a fever, or from a more chronic form of mental 
disease. Most assuredly, if regarded from an equitable 
standpoint, the policy should not be forfeited under these 
latter circumstances, any more than if the death of the 
insured had been caused by apoplexy, or by any casualty. 
How absurd it would seem for any company to make its 
insured responsible for that diseased mental condition which 
may culminate in an insane act of self-destruction, any 
more than for an attack of phrenitis, arachnitis, or typhoid 
fever, in all of which there may be acute delirium, driving 
its victim to an act of suicide ! We are decidedly of the 
opinion that the line should be sharply drawn, in cases of life 
insurance, between intelligent suicides and insane suicides ; 
the former being held responsible for the act of self-destruc- 
tion, and, therefore, vitiating their policy ; while the latter 
are to be regarded as irresponsible, and consequently not 
vitiating their policies. Any other ruling appears to us 
both unjust, and lacking common honesty. 

And just here we should not lose sight of the very im- 
portant distinction between doing an act intentionally ^ and 
doing it intelligently. The insane person, equally with the 
man of sound intellect, commits the suicidal act intention- 
ally ; i. e., he cuts his throat, shoots himself with a pistol, 
drowns, or hangs himself, intending to take his own life 
thereby ; but there is this all-important distinction between 
the two : the sane man does the deed intelligently, as well as 
intentionally, fully aware, at the time, of the illegality of the 
act and of all its consequences, both here and hereafter. The 
insane man, on the contrary, commits the act with his mind 
not in its normal equipoise, but swayed by an insane delusion. 

There is a form of suicide which might give rise to con- 
siderable casuistry in cases of life insurance ; where a person 



556 MEDICAL JURISPRUDENCE. 

in the habit of using powerful drugs, such as laudanum or 
chloral, for medicinal purposes, takes a very large dose 
while in a state of intoxication, and dies. In such a case, 
the act of self destruction, not being intentional, could 
hardly be dQQVC\Qdfelo?tious, and therefore not comingwithin 
the statute. But, on the other hand, as drunkenness is not 
a legal excuse for homicide, it might be made to affect the 
question of suicide also, which thus, under the circum- 
stances, might be held as felonious killing. 

As remarked by Taylor, if suicide was in all cases the 
result of insanity, the act ought to be more frequent among 
the insane ; but experience does not favor this idea. The 
Report of the Commissioners of Lunacy for 1850 shows 
that out of 15,079 persons that year confined as lunatics, 
there occurred only eight suicides. 

The suicidal tendency, or impulse, appears at times to 
assume an almost epidemic tendency in a community. Imi- 
tation has, undoubtedly, much to do with this, especially 
when the mode of self-destruction adopted, and the attend- 
ing circumstances, were of a peculiar sensational character. 
Thus, a second and a third suicide took place in rapid suc- 
cession, soon after the first occurred, from the top of the 
monument in London. The same thing occurred in Paris, 
from the Napoleon monument. Dr. Forbes Winslow states 
that, " some years ago, a man hung himself on the thresh- 
hold of one of the doors of the Hotel des Invalides. No 
suicide had occurred in the establishment for two years 
previously ; but in the succeeding fortnight five invalids 
hung themselves on the same cross-bar, and the governor 
was obliged to shut up the passage." The tendency to 
suicide seems to be hereditary in certain cases, extending 
through several generations. But in all these instances, 
there were other unmistakable evidences of a deranged mind. 



INSANITY PUERPERAL MANIA. 657 

Puerperal Insanity. — This form of insanity attacks 
women after delivery, at a period varying from a few days 
to several weeks. It is said to occur most frequently before 
the stoppage of the lochia. It is usually attended with the 
appearance of albumen in the urine, and with the interrup- 
tion, or suppression of the milk and lochia. The disorder 
may assume any form of mania, from the grave to the gay, 
loquacious, taciturn, correct, or foul in talk, attended with 
delusions of a religious character, or of persecution. She 
is apt not to recognize persons, and to forget recent events. 
Her infant is either totally disregarded, or becomes the 
object of her stealthy destruction. Instances are reported 
of the most horrible murders of their offspring by mothers 
suffering under this form of insanity. Crimes of this char- 
acter are sometimes committed from a seemingly sudden 
impulse ; whilst, in other cases, they may be preceded by 
torturing doubt; and the very sight of the child has aroused 
the almost invincible desire to murder it. We knew a lady 
who had completely recovered from her first confinement, 
and was able to go out. One day, several weeks after the 
birth of her child, she was visiting at a friend's house, 
when, all of a sudden, she broke out into the most violent 
paroxysm of mania, requiring bodily restraint. She took 
a strong dislike both to her husband and child. She was 
treated in different asylums for about one year, when she 
completely recovered, and has continued well ever since, 
having also given birth to another child. Women suffering 
from puerperal mania are apt to commit the most unexpected 
crimes, which, at times, may be misunderstood by juries, 
and may be mistaken for instances of intentional infanticide. 
Fortunately, however, the crimes are brutally executed, and 
often more than one person is murdered, so that no doubt 
can be raised as to the real condition of the patient. 



558 MEDICAL JURISPRUDENCE. 

SECTION V. 
DEMENTIA.— GENERAL PARESIS.— POST-MORTEM LESIONS. 

DEMENTIA DIFFERS FROM MANIA. — SYMPTOMS; — SENILE DEMENTIA, — 
GENERAL PARESIS OF THE INSANE. — CHARACTERS. — POST-MORTEM 
LESIONS OF THE INSANE. — LESIONS IN IDIOCY; IN ACUTE AND 
CHRONIC MANIA ; IN MELANCHOLIA ; IN GENERAL PARESIS ; IN 
EPILEPTIC MANIA ; IN SENILE DEMENTIA. 

Dementia. — This term is used to define the condition 
manifested by a decay of the mental powers. Commencing 
with a gradual enfeeblement of the mind, it may terminate 
in its total extinction. It differs totally from mania in being 
attended by a lack of ideas, whilst the former is character- 
ized by an exuberance of ideas, although these are confused 
and incoherent. Dementia is essentially a disease of depres- 
sion ; mania, one of excitement. It may follow acute mania 
or melancholia, or result from cerebral organic disease or 
injury, and it is a frequent accompaniment of old age (senile 
dementia). Its most striking symptom is loss of memory, 
this faculty being the first to show signs of decay. This 
progressively increases, until everything seems to be for- 
gotten by the patient, even what he has seen, or heard, or 
done, only a few moments before. 

The general mental feebleness is further manifested by 
the " wavering play of worn-out emotions, incoherence, and 
half-formed and varying delusions " (Hamilton). The delu- 
sions are of a suspicious character; the patient is unde- 
cided, childish, and silly in his manners; his conversation is 
incoherent ; he will repeat words or sentences without any 
meaning; he manifests neither partiality nor aversion to 
former friends or acquaintances ; he moves about aimlessly, 
for hours, or may remain for days in the same attitude. 
There is often a strong disposition exhibited for hoarding 
up useless articles, as if they were of great value. The 



GENERAL PARESIS OF THE INSANE. 559 

countenance is generally pale, vacant, and without expres- 
sion ; the look vague and uncertain, and tears are often 
easily shed, from the slightest cause. 

Secondary dementia, following disease of the brain, is 
usually gradual in its approach, the decay of one mental 
faculty following another, and accompanied, also, with pro- 
gressive physical weakness. Such cases are frequently 
attributed to softening of the brain, and are so popularly 
named ; and there is probably no sadder spectacle to wit- 
ness than the gradual decay, through disease, of both mind 
and body, in one whose former brilliant intellect is slowly 
but surely giving place to the fatuity of dementia. 

Dementia is thought to follow mania more frequently 
than melancholia; and although it may seem to resemble 
the latter form of insanity in some of its features, it differs 
from it in exhibiting less coherence of ideas, and less ability 
to keep up the continuity of the delusions. 

Senile dementia is usually marked by a failure of both 
the bodily and mental powers ; it exhibits itself by loss of 
memory, and childishness. The old man is cross and petu- 
lant, uncertain in his action, careless, and often filthy in his 
habits; wandering about aimlessly; often foolishly extrava- 
gant. He may gradually sink into a state of complete 
fatuity, and finally die of exhaustion. 

General Paresis of the Insane. — This is a true disease 
of the brain, characterized by the combined presence of 
both mental and motor symptoms. Its approach is gradual 
and insidious. It often follows dissipation, alcoholism and 
syphilis, and likewise mental overwork of any kind — any 
cause that occasions a continuous overstrain, up to the point 
of exhaustion, upon that portion of the cerebral mass in 
which mentalization especially resides. Clouston (^Men. Dis., 



560 MEDICAL JURISPRUDENCE. 

Am. ed., 1884, p. 275) shows this function to be especially 
located in the gray substance of the convolutions. Its outer 
layer or rind is most delicately constituted, has far more 
blood and more minute cells than any other portion of the 
brain, and on the whole may be regarded as the most im- 
portant factor in mentalization, being, in fact, the mind 
tissue. General paralysis is a disease of this outer layer of the 
cerebral convolutions — of the mind-tissue, in fact. ** It is 
essentially a death of that tissue. It is equivalent to a 
premature and sudden senile condition — senility being the 
slow physiological process of ending, general paralysis the 
quick pathological one. The causes of it are causes that 
have exhausted the trophic energy by over-stimulation." 

It may begin with scarcely perceptible alterations in 
manner, fretfulness, irritability and carelessness in habits, 
which are soon succeeded by ridiculous boastings of his 
possessions and personal abilities {delusions of grandeur). 
These delusions assume various forms and expressions; 
sometimes it is enormous wealth of money and jewels ; 
again, it is herculean strength of body or wonderful mental 
capacity; again, it may take the form of extraordinary 
sexual capacity. Along with these, there is the most foolish 
extravagance, purchasing the most useless articles and 
throwing away his money with the most reckless prodi- 
gality. " At this time there will be noticed a loss of mus- 
cular power ; at first, the tongue will tremble when pro- 
truded ; then the lips become tremulous, and the corners of 
the mouth uneven. The speech is clumsy, and there is 
great difficulty in pronouncing the labial and lingual conso- 
nants" (Hamilton). The pupils are apt to be unequally 
dilated, or they may both be much contracted. 

As the disease advances, the gait becomes unsteady and 
trembling. Vision is also impaired, as are also the other 



POST-MORTEM LESIONS OF THE INSANE. 561 

senses. Fits of violence often alternate with a melancholic 
condition, and epileptic and hemiplegic attacks may compli- 
cate the case towards the last ; but, as has been already- 
suggested, these may be indications of some organic dis- 
order which occasionally accompanies this disease. 

Among the frequent accompaniments of this form of 
insanity, Clouston alludes to the " insane ear" or hoejnatoma 
auris, a bloody, gelatinous swelling of the ear, usually the 
result of a blow upon that organ, although sometimes of 
spontaneous origin. Its occurrence is always an unfavor- 
able prognosis in this and other forms of insanity. " It is 
connected with arterial degeneration in the branches of the 
carotid artery. The contents of a haematoma auris are like 
the extravasations under the dura mater in pachymeningitis 
hemorrhagica interna^ a disease that is liable to occur ixv 
precisely the same class of persons." 

There are periods of remission in general paresis, during 
which the individual appears quite sane. These may last 
for weeks or months. During these intervals the question 
of his testamentary capacity may be raised, which, of course, 
would have to be decided according to the actual mental 
condition of the patient. If under an extravagant delusion, 
extravagant and unjust bequests were made, these should, 
undoubtedly, be set aside, as being the offspring of a 
deranged mind. 

The prognosis in general paresis is always unfavorable ; 
the disease invariably progresses to a fatal termination, in 
from two to eight, or ten years. 

PosT-MORTEM LESIONS OF THE Insane. — Modem research 
has done much to elucidate what was formerly very ob- 
scure, touching the true pathology of insanity. We think 
we are justified in stating that, in every case of true insanity, 
25 



562 MEDICAL JURISPRUDENCE. 

especially in the chronic form of the disorder, there are 
positive pathological changes produced in the brain, 
although these may, at times, be too subtle and recondite to 
be discovered by our present means of research. If it be 
true that every abnormal alteration of function in an organ 
involves, for the time, an alteration of structure (although 
this may not always be capable of demonstration to the 
senses), it would seem most reasonable to refer those 
abnormal displays of the intellectual and mental functions, 
which accompany insanity, to some structural change in the 
different parts of the cerebral structure. 

It is a most vague and unsatisfactory mode of expression 
to speak of a diseased mind, as if the incorporeal, impalpable 
entity, which we teim 7nind, was the real seat of disease ; 
whereas, the true condition would seem to be that, as the 
mind can only act, in our present state of being, through 
the brain, a diseased condition of the latter organ must 
necessarily affect and distort the different mental manifesta- 
tions. The doctrine that insanity is due to diseased physical 
media seems to be most consistent with sound philosophical 
and physiological views, — and we may add, also, with sound 
therapeutical views. For, as has been well urged, on what 
other grounds do we administer material remedies in cases 
of insanity, except with the expectation that these remedies 
will remove disease from the media (the brain) ? When 
this is accomplished, the manifestations of the mind's 
operations again become normal and natural. 

The above view by no means necessitates the idea of the 
mind being rnQveXy a fimction of the brain, and, therefore, as 
favoring materialism ; on the contrary, it supposes the mind 
to be a separate, incorporeal entity, but entirely unknown 
to, and unappreciable by us, save through certain physical 
media; and neither the physician, nor the medical jurist can 



IDIOCY AND IMBECILITY PATHOLOGY. 563 

be brought into contact with mental derangements, except 
indirectly, through the abnormal condition of the brain. 

But, on the other hand, it must be remembered that 
extensive disease of the brain may exist, and sometimes 
exhibit pathological changes very similar to those accom- 
panying insanity, without any indication of this latter dis- 
order. W/ij/ this should be so, we are unable distinctly to 
say. Heredity and other occult causes may produce effects, 
whose operations we are not yet prepared fully to understand 
and explain. 

It is a popular but erroneous idea that the largest brains 
belong to persons of the greatest intellect ; this is far from 
the truth, as one of the largest on record belonged to an 
idiot. 

In an autopsy of the brain in a case of insanity the points 
for consideration are its size, weight and configuration, 
the appearance of the convolutions, depth of the gray sub- 
stance, and marks of recent or chronic disease. In general, 
it may be stated that, in chronic cases particularly, the 
appearances commonly met with are thickening of the 
cranial bones, close adhesion of the dura mater, congestion 
of the pia mater, with opacity and thickening of the arach- 
noid. There is also general fullness of the blood vessels, 
with remains of old cysts, hardened deposits, or even 
abscesses in the cerebral substances ; alterations in the form 
and structure of the convolutions and depth of the gray 
matter ; also effusions of blood and serum, the latter into 
the ventricles, together with alterations, and atrophy of the 
nerve cells. 

In Idiocy and Imbecility, the brain is usually smaller than 
natural (although there are exceptions), with partial atrophy 
of the convolutions, particularly the frontal. There is also, 
generally, a want of correspondence between the two lobes. 



564 MEDICAL JURISPRUDENCE. 

The fissure of Sylvius is also, according to Luys, usually 
enlarged, extending much farther back than in the normal 
brain. In these cases there has been a true arrest of develop- 
ment, depending upon some defect in the cortical substance, 
from which intellectual nutrition should have been supplied. 

In Acute Mania, the most common lesion is intense hyper- 
semia along the whole margin of the gray substance of the 
convolutions, and also in areas below them. This active 
congestion is not, however, to be regarded as the primary 
cause of mania, otherwise, this latter disorder would fre- 
quently be the sequence of meningitis. According to 
Luys, the vessels of the corpora striata are most dilated 
and engorged. 

Clouston describes a singular pathological condition, 
noticed in a case of acute mania, consisting of a copious 
deposit of an abnormal material over the entire convolu- 
tions, " chiefly in their inner layers, and extending, in some 
places, into the white substance, and replacing, at least, 
two-thirds of the gray substance. In many places, it was 
deposited in masses around the arteries." But, that such 
an abnormal deposit is necessary to produce all the symp- 
toms of violent mania, is fully disproved (as the author 
remarks) by the fact of its entire absence in other numerous 
cases. 

The pathological changes exhibited in Chronic Mania are 
not pathognomonic. We generally find thickening of the 
membranes, some atrophy of the convolutions, local con- 
gestions, together with disease of the coats of the vessels, 
with occasional spots of softening. There is, usually, 
thickening of the bones of the skull, with occasional exces- 
sive bony deposits on the inner surface. 

In Melancholia, " Luys found, in several cases, great 
hyperaemia of the gray substance of the third ventricle. 



SYPHILITIC INSANITY PATHOLOGY. 565 

This gray matter on the cortex of one of these patients 
was thin, and most of the convolutions were pale, with 
irregular vascular arborizations. In some cases of profound 
melancholia with stupor, the brain was completely exsan- 
guined, the white substance deprived of vessels, with atrophy 
of the cortex " (Hamilton). 

The pathology of Epileptic hisanity, like that of epilepsy, 
yet remains very obscure. According to Dr. Clouston, who 
has examined numerous cases of this disorder, *' there is no 
special lesion or abnormality." Among other lesions, he 
has found " spiculse of bone from the skull-cap and mem- 
branes pressing into the convolutions, apoplexies, destructive 
lesions of the brain of all kinds and in all places, embolisms, 
fatty and otherwise, adhesions of the pia mater to the con- 
volutions, the marks of traumatic injuries of all kinds and 
in all places, unequal hemispheres, and congestions of all 
sorts and in all places." This author does not believe that 
the source of irritation, in epilepsy, exists in the pons and 
medulla oblongata, but thinks that an irritation of the 
motor area of the convolutions is far more apt to cause it 
than one anywhere else. 

In Syphilitic Insanity, we may expect to find a variety o{ 
pathological changes, consisting, chiefly, in thickening of the 
bones of the cranium, and of the membranes which adhere 
to the bone and to the convolutions ; atrophy of the convo- 
lutions, adventitious deposits in the gray matter; softening 
and disappearance of the white matter; tumors {syphilomas^ 
in different places ; hypertrophy of the coats of the arteries, 
obliterating their lumen, thus causing atrophy of the struc- 
ture. From numerous recent examinations, we think there 
can be no doubt of the tendency of syphilis to ultimately 
attack the brain, after having lain latent for many years. 
Moreover, it appears that the tendency of the disease 



566 MEDICAL JURISPRUDENCE. 

toward the nervous system is in the inverse ratio to the 
development of primary and secondary symptoms. 

In Senile Dementia, the most usual pathological lesions, 
according to Clouston, are localized softenings of the cere- 
bral structure, the result of cutting off the blood supply 
through embolism, atheroma of the arteries ; also, a marked 
atrophy of the whole brain, or of considerable portions of 
the convolutions. The membranes are commonly thick- 
ened, and the cerebro-spinal fluid milky, superabundant, 
and full of microscopic debris. The larger nerve-cells are 
degenerated and disappearing, along with atrophy of the 
smaller cells and nuclei. 

SECTION VI. 

MEDICO-LEGAL RELATIONS OF INSANITY. 

DEPRIVATION OF LIBERTY. — SIGNING CERTIFICATES OF LUNACY. — 
TESTIMONY IN CRIMINAL CASES. — TESTAMENTARY CAPACITY. — 
GIVING OPINION IN RELATION TO MARRIAGE, AND EDUCATION OF 
CHILDREN. 

The duties of the medical practitioner, in connection 
with cases of real or alleged insanity, involve a very grave 
responsibility on his part, and require the exercise of con- 
siderable knowledge, experience, judgment and caution. 
The most important of these duties are the following : — 

1. Assuming the responsibility of treating cases at home, 
assigning them attendants, restricting their liberty, and pre- 
venting their attending to their ordinary business. This is 
a serious undertaking, and the physician will do well, in 
such cases, merely to act as an adviser, but to assume no 
responsibility in the restraint; this should devolve upon 
some relative of the patient. 

2. To sign the proper certificate for the admission of the 
alleged insane patient into a public, or private asylum. This 



INSANITY MEDICO-LEGAL RELATIONS. 567 

measure may become necessary, both for the good of the 
patient and for the safety of the pubHc ; but, as interested 
relatives and others might possibly combine to commit a 
sane person into an asylum, and the physician, in such a case, 
is liable to be imposed upon, he should exercise the greatest 
caution and judgment before giving his signature. Other- 
wise, he renders himself liable to heavy punishment, by an 
action at law, for false commitment. The form of certificate 
is fixed by statute, and no other is valid in the United States. 
This must be signed and sworn to by one or more respect- 
able physicians, who have previously visited, and examined 
the patient. In Pennsylvania, the law requires the signa- 
tures of two physicians, who have been in practice for at 
least five years, and who have examined the patient sepa- 
rately within one week of their signature, and who testify 
under oath of the necessity of placing him (or her) under 
the restraint of an asylum. The persons applying for the 
admission of the patient must also sign a responsible bond, 
setting forth their reasons for the request, giving a history 
of the patient's symptoms, and probable cause of the attack. 
The physicians who sign the certificate must have no con- 
nection with the hospital, nor be related by blood, or mar- 
riage to the patient. 

Before certifying to the insanity of a patient, under any 
circumstances, the practitioner should first conscientiously 
determine the fact of the insanity; and, for this purpose, he 
is compelled to make a careful personal examination of the 
patient. This may require several visits in some cases, 
where the cunning of the lunatic may at first baffle the 
physician. Then, as to the " setting forth the facts " upon 
which the physician's opinion is based, great care and expe- 
rience are required, in order to give only such " facts " as 
are really demonstrative of the alleged mental disorder. 



568 MEDICAL JURISPRUDENCE. 

3. In the discharge of lunatics, the same caution and 
judgment are required on the part of the physician. Patients 
sometimes obtain their discharge from an asylum, contrary 
to the wishes of the superintendent, on a writ of habeas 
corpus, and they not unfrequently bring an action against 
both the superintendent and the physicians who signed 
the certificate, for false detention. But, generally, they are 
• removed by their friends, when sufficiently recovered, at the 
discretion of the superintendent. In this country there is 
no legal restriction on the liberation of the insane on their 
recovery, except in cases of homicidal, or otherwise dan- 
gerous lunatics, who have been confined by order of the 
courts. 

4. Medical men are often called upon to give evidence as 
to the existence, or not, of insanity in a criminal under sen- 
tence of death, in order to stay execution. For this pur- 
pose, it is usual for the court to appoint a commission of 
three or more persons, the majority of whom shall be expe- 
rienced physicians, to determine the question. 

5. In a trial for homicide, where the defence of the 
prisoner is based upon alleged insanity, the court summons 
experts whose duty it is to investigate the patient's mental 
condition, both before and at the time of the commission of 
the crime. 

6. In civil cases, the physician is constantly appealed to, 
as e. g., to determine the testamentary capacity of one 
making a will, or signing a contract, or contracting a 
marriage, or transacting ordinary business. As regards 
testamentary capacity, it is understood that the law requires 
a less amount of mental capacity for making a will, than for 
managing property, or enjoying personal liberty. Patients 
in asylums have made good wills. Patients with insane 
delusions that did not affect the provisions of the will, and 



INSANITY MEDICO-LEGAL RELATIONS. 569 

where these were just and reasonable, have been held by 
the highest tribunals to have made good wills. The most 
absurd and eccentric wills have been held by the courts to 
be valid, where such wills were shown to be in perfect 
accordance with the whole former life and character of the 
eccentric (but not insane) testator. 

In order to make a valid will, the law requires that the 
testator should be sane at the time he makes it. Hence, 
temporary drunkenness, the delirium of a fever, narcotism 
and similar conditions would, for the time, disqualify him. 
But a person may be suffering from the effects of a powerful 
poison — arsenic or strychnine, for instance, — provided his 
brain is not affected, so that his intelligence is not impaired, 
and his will made under these circumstances will be per- 
fectly valid. The question has been raised of the validity 
of a will made by a person suffering from typhoid fever ; 
the answer should certainly be affirmative, provided he was 
not delirious at the time. In an English case, it was held 
that neither erysipelas nor fever would invalidate a will, but 
that the stupor and drowsiness induced by them would. 

As regards paralysis, it has been settled that this is not 
sufficient to invalidate a will, even if it be accompanied with 
aphasia or loss of speech, always provided the mental 
powers were good. The same is true of the collapse of 
cholera, where the patient is unable to speak from exhaus- 
tion, but where the mental powers continue unimpaired. 

In epilepsy, unless it can be proved that the repeated 
attacks have affected the mind, so as to have completely 
unhinged it, it has been decided that the patient has a 
perfect testamentary capacity in the intervals between the 
paroxysms. The case of the Duchess of Manchester (1854) 
is one in point. She executed a second will about three 
weeks before her death. She had had repeated attacks of 
25* 



570 MEDICAL JURISPRUDENCE. 

hysteria and convulsions, along with delusions. The 
attending physician deposed that, on the day of executing 
the will, and for some days previous, the Duchess had 
recovered her reason, and that at the time of signing it she 
was, in his judgment, aware of what she was doing, and that 
she voluntarily delivered it as her own act and deed. It 
appeared also that the disputed will was substantially such 
as the Duchess had announced before that it was her inten- 
tion to make. At the trial, several medical witnesses gave 
their opinion that the Duchess was of unsound mind, and, 
therefore, incapable of making a will. But the point at issue 
was — Was she, at the time of executing the will, in a com- 
petent state of mind ? The jury found that she was com- 
petent, and that the will was valid. 

When a physician is asked to examine into the testa- 
mentary capacity of a patient before executing his will, it 
will be well that the interview should be strictly private, or 
else in the presence of the nurse, or some one member of 
the family, in order to ascertain the true condition of his 
mind — whether it is free from the action of drink, or narcotics; 
whether he knows the nature of the act he is to perform ; 
whether he is influenced as to the manner of doing it by 
any insane delusions prompting him thereto ; and, finally, 
whether any undue influence is being exerted over him from 
without. It may happen that, in a private interview, a dying 
man might disclose to his physician the fact of such an 
improper influence, from which he was desirous of escaping, 
but which had become dominant over him in consequence 
of his weakness. 

7. The medical man may be asked his opinion in refer- 
ence to the propriety of contracting a marriage with a party 
who has been insane, or who has an insane heredity. This 
is often a most delicate and responsible position for him to 



INSANITY CRIMINAL RESPONSIBILITY. 571 

occupy. Our own views are adverse to men marrying 
women who have been insane, as a general rule ; certainly, 
if there was also an insane heredity, the risk is very great. 
A sporadic case of insanity, depending on some special 
cause, and perfectly curable, may occur in any family; this 
might be excepted from the advice above given. 

Then, also, as to the proper training and education of 
children of insane or neurotic parents, medical advice is 
often very properly sought, and followed. Such children 
should, of course, be brought up on strictly physiological 
principles. Pure country air, simple but nourishing diet, 
plenty of out-door exercise, the avoidance of all improper 
excitement, especially towards the period of puberty, and 
the subordination of their intellectual studies to their phy- 
sical health — these are the points to which the attention 
should be specially directed. 

SECTION vn. 

CRIMINAL RESPONSIBILITY.— THE PLEA OF INSANITY AS A 
BAR TO CAPITAL PUNISHMENT. 

IMPORTANCE OF A CORRECT UNDERSTANDING OF THE SUBJECT TO 
THE MEDICO-LEGAL STUDENT. — A MERE " KNOWLEDGE OF RIGHT 
AND wrong" NOT SUFFICIENT. — THE CONDITION OF THE WILL, 
OR SELF CONTROL. — EMOTIONAL INSANITY. 

There is no aspect of insanity of more profound interest 
to the medical jurist, nor of greater importance both to him 
and to the community, than that of responsibility in criminal 
cases. The reader need not be reminded that there exists a 
vast deal of sentimentalism upon the question of capital 
punishment for the crime of murder, and that, in nearly 
every trial for homicide, no matter how atrocious the cir- 
cumstances of the crime, the attempt is made, after every 
other expedient has failed, to prove the insanity of the 



672 MEDICAL JURISPRUDENCE. 

prisoner at the time of the commission of the murder. After 
clearing away the mass of rubbish that obstructs the path- 
way to a clear comprehension of the subject of criminal 
responsibility — divesting it of all its mere technicalities and 
subtleties — we are forced to come down to the true test — 
mental disturbance arising from disease. In the words of 
Dr. Bucknill : " The element of disease, therefore, in abnor- 
mal conditions of mind, is the touchstone of irresponsibility, 
and the detection of its existence, or non-existence is the 
peculiar, and oftentimes the difficult task of the psycho- 
pathist." 

But the question immediately occurs — How is the exist- 
ence of this alleged mental disorder to be determined? 
What are the tests of its presence in the criminal at the bar 
of justice? In England, formerly, the doctrine was "that 
every man was responsible for his acts unless he was totally 
deprived of his understanding and memory, and did not 
know what he was doing, no more than an infant, than a 
brute, or a wild beast " {R. v. Arnold^. In the case of 
Bellingham, " the knowledge of right and wrong " in the 
abstract was the test of mental unsoundness ; and as, in the 
opinion of the judge and jury, he was held to be capable of 
solving this metaphysical problem, Bellingham was duly 
hanged. Since the trial and acquittal of MacNaughton 
for the murder of Mr. Drummond, on the ground of insanity, 
the doctrine of the knowledge of abstract right and wrong 
has been changed to a knowledge of right and wrong in 
relation to the particular act of which the person is accused, 
and also at the time of committing it (Husband). But a 
step farther has been taken : " he must also have a know- 
ledge of the consequences of the act." 

The real knowledge of the difference between right and 
wrong has been the test for years, yet it is neither sufficient 



INSANITY CRIMINAL RESPONSIBILITY. 573 

nor satisfactory. There can be no doubt that many insane 
persons have committed acts which they knew to be wrong, 
and of the criminality of which they were at the time per- 
fectly conscious ; as they were also of their penal conse- 
quences. Some have been known to commit murder with 
the avowed intention of receiving the punishment of death 
at the hands of the law, instead of inflicting it suicidally 
upon themselves. Dr. Maudsley criticises the above ** test" 
very truly, when he says : " Here is an unhesitating assump- 
tion that a man having an insane delusion has the power to 
think and act in regard to it reasonably ; that he is, in fact, 
bound to be reasonable in his unreason, sane in his insanity." 
The decisions in the American courts have generally 
been similar to those of England, the dominant idea being 
a knowledge on the part of the criminal of the wrong 
nature of the act in question — ** its criminality, not only 
against the laws of man, but also against the laws of God 
and nature." The doctrine laid down by Mittermaier 
appears to us to cover the ground more completely. He 
regards the will as the most important factor in the case. 
He rebukes the English jurists for their rigid adherence to 
the antiquated doctrine, that whoever can distinguish good 
from evil enjoys freedom of will, and retains the faculty 
(if he chose to use it) of framing his action to the require- 
ments of the law. " A person who commits a criminal act, 
being fully cognizant of the nature of the law, and of the 
punishment to which he is exposing himself, may yet be of 
insane mind. The true test of irresponsibility should be, 
not whether the party accused was aware of the criminality 
of his action, but whether he has lost all power of control 
over his actions!' According to Dr. Hamilton, " the true 
test, after all, is the condition of the will." With this Prof. 
Ordronaux substantially agrees, when, speaking of criminal 



574 MEDICAL JURISPRUDENCE. 

responsibility, he adds, In addition to the defendant knowing 
the nature and consequences of the act, and having a felo- 
nious Intent In Its commission, that ** he had the power to 
choose between doing a?td not doing it ; and, supposing this 
power to be lost, it Is lost solely through disease^ and not 
through temporary inebriety, or violent anger." 

The above doctrine seems to us to be the correct one ; it 
is founded on sound psychological principles, and certainly 
cannot be accused of bearing harshly or Inhumanly against 
the prisoner. It places his Irresponsibility for the criminal 
act exactly where It ought to be placed — on a distorted 
mind. Moreover, a thorough understanding of these views 
by medical experts, and a more general dissemination 
through the community of the important doctrine that 
Insanity Is a disease^ and not a mere outburst of anger, or 
even a series of emotional acts, will contribute not a little 
to educate the people as to the reasonable and proper 
grounds to be taken. In those cases of homicide where the 
plea of insanity Is urged as a bar to capital punishment. 
This is not the occasion to argue for, or against the lawful- 
ness, or the expediency of capital punishment. As long as 
it Is upon our statute books, the law must be obeyed, and 
no mere sentlmentalism should be suffered to Interfere with 
its execution ; and, above all, no tricks of an adroit counsel 
should be permitted so to blind the eyes, or Impose upon 
the understanding of the court and jury, as to cause them 
to mistake an outburst of sudden anger, even under a 
grievous provocation, or a cool, deliberate murder, although 
seemingly justified by a most outrageous wrong, for an act 
which can be satisfactorily shown to be the direct result of 
a disordered intellect, or a dethroned reason. 

Irnpidsive, or emotional insanity^ as it Is named, Is often 
urged as a defence for crime, especially homicide. It is the 



IMPULSIVE, OR EMOTIONAL INSANITY. 575 

plea to which the counsel for the prisoner, when defeated 
in all his attempts to acquit his client, most naturally resorts 
as a sort of forlorn hope, and one which, it must be con- 
fessed, he may most eloquently, and often most successfully, 
employ before a jury, whose sympathies may already have 
been skillfully aroused for the prisoner. But, is the plea a 
sound one ? Can it be possible that an individual can be 
sane immediately before, and immediately after the com- 
mission of an act, and insane ojily at the moment of its 
commissio7i ? We certainly think not. A well known 
writer thus expresses himself: " I see no ground on 
which to rest an hypothesis of an impulsive insanity, or 
to justify an incorporation in our medical jurisprudence 
of such a form. I cannot conceive of a homicidal act, 
impulsive, without motive, delusion or passion, simply a 
so-called impulse to kill; and a careful analysis of clinical 
cases under my own observation, as well as a large experi- 
ence in the examination of criminals, sustains this view. 
Impulsive disease cannot exist. The term impulse, used to 
describe certain acts of the insane, executed suddenly and 
without apparent premeditation, may be proper enough as 
qualifying a mental state during an act, as impulsive homi- 
cide, but this does not justify the transposition into homi- 
cidal impulse. Such transposition would show, not that 
the acts were apparently unpremeditated and sudden, but 
that, in the mind there was suddenly generated a murderous 
impulse, an irresistible power, which, without the interven- 
tion of reason, or any intellectual act or motive, suddenly 
impels to the physical act. Man is not the prey to blind 
impulse " (Quoted by Hamilton). 



576 MEDICAL JURISPRUDENCE. 

SECTION VIII. 
SIMULATED, OR FEIGNED INSANITY. 

PRETENDED INSANITY IN CRIMINALS. — IMPORTANCE OF ASCERTAINING 
THE MOTIVE. — HAS HE TAKEN ANY MEASURES TO CONCEAL THE 
CRIME, OR TO ESCAPE ? — MANIA, THE FORM OF INSANITY MOST 
FREQUENTLY FEIGNED. 

There is probably no subject in medico-legal practice 
which causes the physician more trouble and anxiety than 
the disputed mental condition of an individual. If the 
question of feigned bodily diseases {ante^ p. 419) often 
occasions considerable difficulties, how much greater will 
be his perplexity and doubt when he comes to deal with the 
subtle workings of the mental operations. Insanity is not 
unfrequently pretended by persons accused of criminal 
offences, in order to procure an acquittal, or a discharge 
from prison. In the first place, when feigning is suspected, 
we should ascertain whether there was a motive for pre- 
tending to be insane. Remember that insanity is never 
assumed until after the commission of a crime, and the 
detection of the criminal. 

A further important point is, to ascertain if the criminal 
deed was, or was not, an isolated act in the mental life of 
the culprit, — whether it originated suddenly in his mind, 
like a flash of lightning from an unclouded sky, or 
^* whether it was not rather the last link of a long chain of 
sinful, criminal desires, hopes and acts" (Casper)? In other 
words, whether it was not just such an act as might have 
been expected from the culprit ? This investigation is of the 
utmost importance, since it does not readily happen that a 
person should suddenly act in a manner diametrically oppo- 
site to all his former character, without some powerful 
psychological cause. 



FEIGNED INSANITY. 677 

This inquiry into motive is often of primary importance 
in the alleged insanity of criminals. The motiveless char- 
acter of a deed is very apt to impress us with a lack of 
good sense, if not of positive mental weakness, in its author. 
Hence, if we can discover a true motive for a criminal act, 
especially where the motive agrees with the disposition of 
the culprit (an important consideration), this would go very 
far to establish the responsibility of the accused at the time 
of the commission of the crime, despite all his affectation 
of insanity. 

There is often great difficulty in getting at this motive. 
In some cases there is no apparent motive; but we should 
not be too ready to admit its absence, since it is indisput- 
ably true that there are as many different motives to illegal 
action as there are different characters ; and what would be 
a powerful motive to one person, might have no influence 
whatever over another, placed under different surroundings. 
** In order to recognize this fact, the inquirer must, in every 
case, place himself in the position of the culprit, and divest 
himself of his own ideas." * * * " No crime, be it what 
it may, is ever committed without a motive ; and the char- 
acter of that motive may be expressed thus : ' the conscious 
impulse to the illegal gratification of a selfish desire ' " 
(Casper). 

A third point in the detection of feigned insanity is to 
ascertain whether the culprit, in carrying out the deed of 
which he is accused, has acted according to any regular 
plan or not ? In most cases, however, this is of but little 
diagnostic value, since many confirmed lunatics evince the 
most surprising adroitness in planning and executing 
schemes for escape, or for enticing their victims whom they 
intend to murder. 

One thing, however, should be remembered in this con- 



578 MEDICAL JURISPRUDENCE. 

nectlon ; generally speaking, in a case of real insanity, the 
individual will, so to speak, break down before he is quite 
through ; that is, he will do, or say something which will 
betray his mental debility. Thus, an insane patient in a 
private asylum near London with the greatest artfulness, 
managed to steal a piece of iron, with which he subsequently 
sawed through the bars of his windows and brought his 
long-cherished plan of flight to execution. These circum- 
stances proved the calmest and most systematic deliberate- 
ness. But here his reason forsook him ; after his escape, he 
ran straight to the Duke of Wellington's house, and 
announced himself as his eldest son. 

A fourth point to be noticed in the diagnosis of a case of 
pretended insanity is, whether the culprit has taken any 
measures to avoid arrest or punishment? Whether, for 
instance, he had adopted any disguise in his personal ap- 
pearance or dress, such as removing his beard, or putting on 
a false one, dyeing his hair, etc., or making preparations for 
escape, or waiting for the darkness of night for the perpe- 
tration of the deed. All such circumstances would create a 
strong suspicion that the accused pretty clearly recognized 
the responsibility of the deed. The really irresponsible 
criminal will usually evince a total apathy about the result, 
and will display a feeling of the utmost security, often 
exulting in the deed, which may even have been committed 
against one of his own immediate family. 

A fifth important consideration in relation to the diagnosis 
is the peculiar condition of the intelligence of the accused, as 
ascertained, on examination, to have always existed, or at 
least for a long time previous to the commission of the 
criminal act (Casper). For example, a criminal may be de- 
fended on the plea of insanity because of his alleged feeble- 
mindedness as displayed in his inability to count, to read 



FEIGNED INSANITY. 579 

and write, to carry on a continued conversation, and the 
like ; but all this may be satisfactorily answered by showing 
that the person has had no previous education whatever, 
and consequently no opportunity of learning any of the 
above matters. Hence the allegation of his being '* silly," 
** childish," " simple," etc., can be of no avail as producing 
irresponsibility for his particular crime. Here the relative 
facts must be ascertained in reference to the case in ques- 
tion — his family history, his mode of bringing up, his 
manner of life, etc., together with the relation of the deed, for 
which he is accused, to the sphere of his intelligence. 

Another point to be noticed is the distinction between the 
hallucinations of the really insane and the alleged " voices" 
and " impulses" of the pretender, forcing him on to the com- 
mission of his crime. It may safely be asserted that, when- 
ever hallucinations accompany real insanity, the latter will 
display itself by other unmistakable signs, so that by 
attentive watching we can generally succeed in distin- 
guishing the genuine from the pretended. 

A strong circumstance bearing on the detection of sus- 
pected insanity is the fact that, in a genuine case of the 
disease, the person will not admit that he is insane ; while 
the pretender will use all his efforts to make you believe he 
is mad. So thoroughly is this the case, that an impostor 
may be induced to perform any act, if it be casually 
observed to another, in his hearing, that the performance of 
such an act would furnish strong evidence of his insanity. 

Mania is probably more frequently feigned than any other 
form of insanity, from the popular notion that insanity is 
made up of violent action, and vociferous and incoherent 
language. But mania seldom comes on suddenly, without 
some obvious cause. A maniacal patient is equally furious 
by night and by day ; an impostor sleeps. Real mania 



580 MEDICAL JURISPRUDENCE. 

manifests itself equally when the patient is alone, or in com- 
pany ; an impostor, only when he thinks he is observed. 
The peculiar restless expression of the eye of mania is hard 
to imitate. The pulse, temperature, state of skin, etc., of 
the genuine disorder cannot be assumed by the impostor. 
Dementia is more difficult to imitate. The discovery of 
any connected ideas, reasoning or reflection, either by lan- 
guage, signs, or writing, would immediately show that the 
patient was simulating. 

Occasional instances, however, are presented of a suc- 
cessful malingering in this line which baffle the detective 
skill of the most experienced examiners. Dr. Bucknill 
mentions the case of Warner, a notorious thief, who was 
sentenced to transportation for fourteen years. Two days 
after the trial, he became apparently insane ; he constantly 
made howling noises, was filthy in his habits, tore up his 
clothes, destroyed his bedding and other articles. He was, 
however, suspected of shamming, and was detained in prison 
for three months. During part of this time it was found 
necessary to keep him in a straight waistcoat. At length a 
certificate of insanity was forwarded to the Secretary of 
State, and he was ordered to be removed to the Devon 
County Asylum. On admission here, he was found to be 
in feeble health. He had an oppressed and stupid expres- 
sion of face ; he answered no questions, but was constantly 
muttering to himself, remaining in the same position for 
hours, either in a standing or sitting posture. He was now 
not dirty in his habits ; he appeared to be, in truth, suffering 
from acute dementia. In three weeks' time he recovered 
his bodily health. This change was too rapid not to suggest 
the idea of deception, but the preceding symptoms had 
been so true to nature, that it was still thought that the 
insanity had not been feigned. For a period of eight 



FEIGNED INSANITY. 581 

months he was well conducted and industrious, and he 
showed no symptoms of insanity. At the end of that 
time he was returned to the jail to undergo his sentence, 
and within one hour after his readmission within its 
portals he was apparently afflicted with a relapse of his 
insanity. From this time, for a period of two years, this 
indomitable man persisted in simulating mental derange- 
ment. He refused to answer questions, walking to and fro, 
constantly howling, and refusing food for days together. 
He would keep beating at the door of his cell, tearing 
up his bedclothes over and over again ; he had a stupid 
expression of countenance, but he slept soundly. He became 
filthy in his habits, but was cured of this by the hot bath. 
He was often visited by the physician, who said he was a 
malingerer. After two years, he suddenly gave up, acknow- 
ledging the deception, and requesting to be transferred to 
the receptacle for convicts. 



582 MEDICAL JURISPRUDENCE. 



CHAPTER XXXIX. 

MEDICAL MALPRACTICE. 

DEFINITIONS. — THE PHYSICIAN NOT AN INSURER. — CERTAIN ESTAB- 
LISHED PRINCIPLES. — "ORDINARY SKILL." — ERRORS IN JUDG- 
MENT. — FREQUENCY OF CIVIL SUITS. — LIABILITY OF DRUGGISTS. 

Malpractice (or malpraxis) may be defined to be bad or 
wrong practice — bad or wrong in its results, whether these 
be loss of limb by amputation, deformity, serious injury to 
health, or even death. 

The responsibility of the medical and surgical practitioner 
has ever been a fruitful theme for medico-legal discussion. 
It is comparatively rare that the subject becomes the source 
of a criminal prosecution, except in cases of foeticide result- 
ing in the death of the mother ; but actions for damages 
before the civil courts, often for large amounts, are alarm- 
ingly frequent, and may well call upon the medical man to 
consider what is his exact legal standing in this matter, and 
what protection he is entitled to claim from the law when 
thus assailed. 

In the first place, it should be clearly understood that the 
physician or surgeon, when called to treat a case of disease 
or injury, does not become an insurer or guarantor to cure, 
any more than an attorney obligates himself to win the case 
for his client. In both instances, the professional man 
merely undertakes to do his best — " to bring to the exercise 
of his profession a reasonable, fair, and competent degree of 
skill." If, however, the medical man be so unwise as to 
contract to make a cure of his patient, he will be held by 
the law strictly accountable for the performance of his con- 



MEDICAL MALPRACTICE. 583 

tract. In case of failure, it will be no defence for him to 
allege the occurrence of unforeseen contingencies, — these he 
was bound to have knowledge of Neither may he allege a 
want of sufficient skill or dexterity ; these he is supposed 
by the law to possess when he undertook the case. Thus, 
if a surgeon contracts to cure a patient of deformity by the 
removal of a limb, and death ensues through pyaemia or 
erysipelas, he will be held liable for forfeiture of his con- 
tract. If a physician undertakes, by contract, to cure a 
woman of an abdominal tumor by the operation of ovari- 
otomy, and death results through an unavoidable peritonitis, 
this will not excuse him. So, likewise, a lawyer contracting 
for the foreclosure of a mortgage will be held liable to his 
client, in case of failure on his part. In all these instances, 
the contract will bind the parties. Their fault and folly was 
to have undertaken what was above their capacity to 
perform. 

In all ordinary cases, where there is no express stipula- 
tion between the parties, the medical man impliedly agrees 
to bring his best skill and endeavors to cure the patient. 
Formerly, the law made a distinction between a fatal issue 
following the treatment of the regular physician and that of 
the quack, regarding the former as only a " misadventure," 
but punishing the latter as manslaughter. But, at present, 
both in the United States and Great Britain, this distinction 
has been abandoned, the court regarding all systems of 
medicine as being entirely on a par, so that, if the practi- 
tioner announces himself, or herself, as belonging to any par- 
ticular school or system of medicine, and practicing as such, 
the patient who employs such a practitioner, and suffers 
thereby either in limb or life, has no legal redress ; he has 
made his election, and must abide the consequences. In- 
deed, it would appear that the charlatan is, under the present 



684 MEDICAL JURISPRUDENCE. 

system of law, much more likely to escape in a suit for 
malpractice, than the most experienced regular physician. 

It may not be always easy to determine just what " the 
ordinary degree of skill" used by law authorities means, 
since what might be regarded as an ordinary degree of skill 
in a large city or centre of medical learning, would probably 
be considered by the untaught and inexperienced residents 
on the frontiers of civilization, as very extraoi^ dinar y skill, 
2.wd, vice versa. Consequently, this term, "ordinary skill," 
must have a varied latitude of application, according to the 
circumstances of individual cases. 

The following principles may be regarded as established, 
being founded on various judicial decisions, both in this 
country and in England : — 

I. If the practitioner acted honestly, and used his best 
skill to cure, and it does not appear that he thrust himself 
in the place of a more competent person, it makes no differ- 
ence whether he was, at the time, a regular or an irregular 
physician or surgeon. This principle has been stretched 
to its utmost limits, even where death has unquestionably 
resulted from the practice of notorious quacks, such as 
St. John Long and Samuel Thompson, although the grossest 
ignorance was proven against them. In the case of Rex v. 
Williamson, 7 B. & C, 497, where an ignorant old man- 
midwife, on one occasion, mistook a prolapsed uterus for a 
placenta, and tore it away by main force, causing fatal 
hemorrhage, Lord Ellenborough, C. J., charged that "there 
was not a particle of evidence to convict the prisoner of the 
crime of murder." The prisoner was acquitted. This case 
illustrates, as Elwell justly remarks, how ignorant a Lord 
Chief Justice of England may be as to the science of medi- 
cine. He appeared to suppose that because an ignorant 
old man had the temerity to act the part of an accoucheur, 



MEDICAL MALPRACTICE. 685 

among a class of low, ignorant women, that therefore he 
must necessarily have some skill ; a most absurd proposi- 
tion. " It no more inferred ' some degree of skill ' in the 
prisoner, because he had delivered some women successfully 
before, thari the fact that a woman who has delivered herself 
of ten or a dozen children, which is often the case, is evi- 
dence that she possesses some knowledge of the uterine 
system." Unquestionably, such a lack of anatomical knowl- 
edge as would cause a man to mistake a uterus for a pla- 
centa should be classed as the grossest ignorance^ and should 
subject the pretender to severe punishment. 

II. Not only ordinary skill, but ordinary care and atten- 
tion to the patient are required of the attending practitioner. 
If a surgeon, for example, after skillfully performing an 
operation, neglects the after treatment, such as proper dress- 
ings and bandaging, and, in consequence thereof, hemor- 
rhage, pyaemia, mortification, or deformity should result, he 
will justly be held responsible in an action for malpractice. 
In every such case, however, if the defendant can clearly 
prove these two points — an average amount of skill and 
competency, together with a proper degree of careful atten- 
tion on his part — he may feel certain of an acquittal, unless 
the trial should happen to be before a stupid jury and a 
prejudiced judge. 

III. As medical men are not infallible, the most skillful 
may err in judgment in advising a particular remedy, about 
which there is a difference of opinion. An error of judg- 
ment, made by such a practitioner, is clearly excusable. 
Lord Mansfield, speaking of attorneys, says : " Every man 
is liable to errors, and I should be very sorry to think that 
it should be taken for granted that an attorney is answer- 
able for every error or mistake, and to be punished for 
it by being charged with the debt he was employed to 

26 



586 MEDICAL JURISPRUDENCE. 

recover ; " and Judge Porter remarks that the agent is not 
responsible, " if the error was one into which a prudent 
man might have fallen. The contrary doctrine seems to 
suppose the possession, and requires the exercise, of perfect 
wisdom. No man would undertake to render a service to 
another on such severe conditions " {Percy v. Millandon, 20 
Mart. R., 75). 

If, however, an unusual and violent remedy has been 
administered, by a person grossly ignorant of medicine, and 
this remedy has caused death, if the individual is of average 
mental capacity, he should be held criminally responsible, 
since such a course would seem to imply malice on his 
part. 

According to the civil law, when the practice of the 
attending physician or surgeon is called in question, the 
prosecution must show, first, that the injury to the health 
or body of the patient actually resulted from the bad treat- 
ment of the practitioner; and, secondly, that this evil result 
might certainly have been foreseen, and avoided by a com- 
petent medical attendant. " Malpractice can only be affirmed 
when the practitioner has set aside established principles, 
and neglected to employ means which are universally held 
to be necessary in the given case." But, before guilt can 
be established on any such derivation, it must be shown 
(i) that the following out of the rules usually prescribed by 
medical science for the cure of disease never proves detri- 
mental; (2) that there is at least the greatest probability that 
the observing of the rules would accomplish the desired 
end ; and (3) that the great majority of medical men approve 
the rules. 

IV. A medical man cannot be held guilty of criminal 
carelessness for failing to employ any particular remedy, 
since there is never any one remedy upon which all authori- 



MEDICAL MALPRACTICE. 587 

ties are agreed; and since it is always possible that the 
patient may recover without the use of such remedy. If 
there existed a specific remedy for any disease, then a neglect 
to use such remedy, on the part of the physician, would cer- 
tainly be criminal, and should be punished as such. The 
uncertainty of remedies must necessarily allow a large lati- 
tude in their selection and employment; and this uncer- 
tainty even affects, to some extent, the use of antidotes in 
cases of poisoning. But where it can be shown that a 
physician called to treat a case of poisoning failed to 
administer the universally accepted antidote, he should be 
held guilty of criminal carelessness^ as, e. g.^ albumen, in 
case of corrosive sublimate poisoning. 

Casper goes farther than this when he asserts that " a 
physician should be held liable to punishment if, in a given 
case, he departs entirely from the treatment which the great 
majority of physicians of his time adopt, and which the 
great majority of medical authorities recommend in such 
cases." But great difficulty would unavoidably result from 
adhering to such a rule ; it might often be impossible for 
the physician to stop to inquire, in any given case, what 
was the practice of the majority of his contemporaries. Be- 
sides, this principle would render all homoeopaths, eclectics, 
botanicals, etc., liable to punishment. 

In consequence of these doubts, the modern practice in 
the United States is that, when a physician announces him- 
self as practicing under some particular system, as the 
homoeopathic, eclectic, or botanical, and is employed by 
persons kiiowing that this is the case, he is, at least, not 
criminally responsible to them, in the event of serious 
result, because his views do not accord with those of what 
are called regular practitioners. Whilst the law prescribes 
no one absolute system of medicine, a practitioner is ex- 



588 MEDICAL JURISPRUDENCE. 

pected to practice according to the system he professes and 
avows ; a departure from this system, if accompanied with 
some serious or fatal mistake of remedy, would render him 
justly amenable to a criminal charge. 

The civil suits for alleged malpractice far outnumber the 
criminal actions. As already observed, the former are so 
alarmingly frequent as to occasion a general distrust, par- 
ticularly among surgeons. A large number of such suits are 
brought evidently for the purpose of blackmail — the plaintiff 
being usually in league with some charlatan of a lawyer, 
with whom he has agreed to share the spoils, and he resorts 
to this nefarious practice as a convenient mode of dis- 
charging his doctor's bill. Such trumped-up cases are of 
frequent occurrence in our civil courts, but generally speak- 
ing, the discrimination of the court is adequate to detect 
and expose the fraud, even to a stupid jury, which is often 
too ready to side with the poor unfortunate plaintiff in a 
trial of this nature. 

Actions of the above character are usually brought 
against surgeons, where certain deformities are alleged to 
have followed unskillful or careless treatment, such as 
shortening of a limb, stiffness of a joint, lameness, or loss of 
a limb. The author was subjected some years ago to an 
annoyance of this character. He was summoned in a hurry 
to attend a man who had fallen from the second story of a 
house upon the pavement below, and who, besides injuring 
his scalp, had received a severe contusion of the hip. The 
man was etherized and carefully examined for fracture and 
dislocation of the hip, with a negative result. He was then 
faithfully attended for five weeks for the contusion, a con- 
sultation, having, in the meantime, been held with an emi- 
nent hospital surgeon, who confirmed the previous diagnosis 
of absence of fracture and dislocation. The man soon got 



MEDICAL MALPRACTICE. 589 

about, but was somewhat lame, from what appeared to be a 
shortened hmb. He was an unprincipled creature, as he 
not only refused to pay a moderate compensation for pro- 
fessional attendance, but some months after he instituted a 
suit for heavy damages against both the medical attendants, 
alleging that the shortened limb was the result of a mistake 
in the diagnosis, and also in the treatment. After applying 
to several respectable lawyers, who declined the case when 
they came to inquire into it, he lighted upon an unscrupulous 
minion of the law, who undertook it for a division of the 
spoils, and who afterwards offered to compromise for a con- 
sideration, which, however, was declined by the defendant. 
On the trial, the defendant was triumphantly vindicated, the 
learned judge (Thayer) delivering a most lucid and compre- 
hensive charge, and the jury acquitting him without leaving 
the box. But he was compelled to submit to the annoy- 
ance and expenses of the suit, all the same [Phila. Med. 
Times, Dec. i, 1870). 

It is a question whether a slight deviation from the ordi- 
nary modes of performing operations should involve a 
charge of malpraxis. Dr. Taylor refers to a remarkable 
case occurring in this country, in which an action was 
brought, and damages recovered against a physician for 
alleged negligence in vaccinating a young woman. Some 
inflammation followed the operation, which, it was alleged, 
was performed nearer the elbow joint than usual. The 
judge, singularly enough, ruled that" the physician is liable 
for all the bad consequences resulting from vaccination or 
inoculation, if he fails to insert the virus in that part of the 
arm usually selected for the purpose, notwithstanding many 
other parts of the body might be proved to be equally 
proper and even more suitable locations ! " This is, in truth, 
as Taylor justly remarks, "a very singular specimen of 



590 MEDICAL JURISPRUDENCE. 

transatlantic jurisprudence." By the same rule, it might be 
deemed necessary always to use the same kind of knife or 
saw in performing an operation. 

Gratuitousness on the part of the practitioner will not 
exempt him from an action for malpractice, if either igno- 
rance or carelessness in his attendance can be proven 
against him. 

A patient who refuses to cooperate with his medical 
attendant, and who thereby sustains injury, cannot recover 
compensation for the injury, unless the latter is clearly 
traceable to the attendant's malpractice. 

It has lately been decided {De May v. Roberts, 46 Mich. 
160) that where a physician took with him, without 
necessity, to a case of confinement, a young unmarried man 
not a physician or student of medicine, and the fact of his 
not being a medical man was unknown to the patient or 
her husband, both the physician and the attendant were 
liable for damages (Wharton and Stille's Med. Jurisp., 1884, 
Vol. Ill, p. 605). 

The liability of druggists rests practically upon the same 
principles that govern physicians. Ignorance and careless- 
ness in putting up prescriptions, whereby gross or even fatal 
mistakes may occur, should justly render them liable to an 
action at law. So, likewise, the entrusting the compounding 
or vending of medicines to careless clerks, or inexperienced 
apprentices would entail criminal responsibility upon the 
principal. 



LIFE INSURANCE. 591 



CHAPTER XL. 

LIFE INSURANCE. 

MEANING OF THE TERM. — CONDITIONS OF THE POLICY. — CONCEAL- 
MENT OF FACTS. — RELATION OF INTEMPERANCE AND SUICIDE TO 
LIFE INSURANCE. 

Insurance on a life is simply a contract whereby the 
company that insures, in consideration of a certain sum, 
payable in yearly or half-yearly instalments, and denomi- 
nated a premium^ agrees to pay to the insured a stipulated 
amount, either to his heirs at his death, or at some definite 
period of his life. The deed by which this contract is made 
is termed a policy. This policy contains a great number of 
provisions and conditions, and it is upon the proper con- 
struction of these that legal disputes frequently arise. 

The amount of premium to be paid depends chiefly upon 
the age of the applicant, though also somewhat upon the 
sex and occupation. 

The amount insured for (if payable at death) cannot be 
recovered until distinct and satisfactory proof of death be 
furnished by the heirs. Upon this proof the companies 
very properly insist with great positiveness, inasmuch as 
fraudulent insurances are so frequently effected, and the 
companies are thereby victimized. 

In case of mysterious disappearance of the insured, with 
no clew to his whereabouts, the law allows an interval of 
seven years to elapse (presumption of death) before pay- 
ment can be pressed ; but it is usual to make the payment 
much before this period, unless there is good reason to sus- 
pect fraud. This is especially true of persons going to sea, 



592 MEDICAL JURISPRUDENCE. 

where the presumption of death may be settled sooner. 
Again, the question of survivorship may be raised, as when 
two or more persons perish by the same calamity — as by 
shipwreck — and where one happens to be insured for the 
benefit of the other : which one is presumed to be the sur- 
vivor ? {vid. ante^ p. 64.) 

Among the " conditions " of the policy, the most im- 
portant one is the general health of the applicant, as influ- 
encing his expectation of life; and it is just here that 
medical science is always appealed to to decide upon the 
applicant's actual condition of health, and his proclivities 
to disease, through hereditary or other cause. The printed 
questions in the policy, under this head, addressed to the 
applicant, are both numerous and pointed; and they should 
always be answered in the most truthful manner, since the 
contract is equally binding upon him, as upon the company; 
and if it is subsequently discovered that any fraud has been 
perpetrated by the insured, through misrepresentation, or 
concealment of facts in relation to disease, or bad habits 
(^.^., alcohol, or opium), his policy will become void, and 
the amount of premiums already paid will be forfeited. 
This is certainly both just and equitable; and no respect- 
able company ever refuses to pay the amount of a policy, 
unless there is a reasonable ground to suspect a willful fraud 
in the contract. 

Still, lawsuits occur very frequently in contested life- 
insurance policies ; and, as in these actions, the sympathy of 
the jury is nearly always with the plaintiff, and the whole 
burden of rebutting proof is thrown upon the company, the 
latter is manifestly at a disadvantage. The contested points 
usually have reference to disputed medical terms or phrases 
in the contract, such as " any other diseases or habits, tend- 
ing to shorten life," etc. It is surprising how often the 



LIFE INSURANCE CONCEALMENT OF FACTS. 593 

applicant will prevaricate and dissimulate upon these last- 
named points, and especially upon their habits, as regards 
the use of alcoholic drinks. From a considerable experi- 
ence in the examination of life-insurance applicants, we 
have found it most difficult to get clear and satisfactory 
answers in relation to the temperate (or intemperate) habits 
of the individual. Often will it be found that the man who 
is in the daily habit of taking three or four drinks of spirits 
will consider himself a perfectly temperate man ; and unless 
he is closely questioned, and made to give distinct replies, 
he may be classed in the policy as *' strictly temperate," 
when all the while his health is undoubtedly being under- 
mined, and his expectation of life thereby shortened, 
although he cannot properly be classed as an inebriate. 

The suppression of a fact in relation to the health of the 
applicant, if not known by him, will not invalidate his 
policy. This was determined in the case of Moulor v. 
A7n. Ins. Co., in an appeal to United States Supreme Court, 
in 1880, in which the author was engaged as an expert wit- 
ness. Here, the main defence was, that some of the answers 
to the interrogatories of the policy were not true, but that 
the insured was, at the time, actually suffering from certain 
alleged diseases, mentioned in the contract. There was 
only one witness to support the allegation, a homoeopathic 
physician, who had prescribed for the plaintiff thirteen years 
before, " for chronic asthma, manifestations of the first stages 
of consumption, and scrofula." The witness did not testify 
positively that the patient had the diseases for which he 
treated him, and, moreover, the testimony was, that " he 
never learned from him, nor from any other physician, nor 
had he ever suspected, or had the remotest idea, that he 
was affected with any such diseases ; but, on the contrary, 
he always boasted of himself as being a strong, healthy and 
26* 



594 MEDICAL JURISPRUDENCE. 

robust man." Clearly, in such a case, the applicant should 
not be held responsible for the suppression of " a fact " of 
which he was utterly ignorant, and of whose very existence 
there was considerable doubt. 

In all cases, the exact state of the applicant's bodily 
health should be ascertained, either by his answers to the 
written categorical questions, or by oral questioning by 
the medical examiner. The case of the Duke of Saxe 
Gotha is cited, as an illustration of the importance of not 
concealing " material facts." This applicant, whilst residing 
abroad, was insured in an English office for the sum of 
;^3000. The certificates of his two German medical exami- 
ners stated that his general health was good, although he 
had an impediment in his speech, and an affection in one 
eye, but that he was perfectly free from disease, or symp- 
toms of disease. The facts were that the Duke had been 
suffering from cerebral disorders for over two years, that he 
was childish, and could not speak. He died of paralysis 
within nine months afterward, and an autopsy disclosed a 
large tumor, evidently of long standing, pressing upon the 
brain, together with an effusion of ten ounces of serum. 
The plaintiff was nonsuited. 

The question of intemperance in relation to the habits of 
the insured causes, probably, more discussion and difference 
of opinion in contested life-insurance cases, than any other. 
It would seem almost impossible to define what intemper- 
ance is. An instance is mentioned by Dr. Taylor which 
illustrates the difficulty of getting at the truth. In South- 
comb v. Merriman (Exeter Spring Assizes, 1842), payment 
was refused on the ground of concealed habits of intemper- 
ance. Twelve witnesses were called by the plaintiff to 
prove that the deceased was a very temperate man, while 
the office called twenty-one to show that he was habitually 



I 



LIFE INSURANCE SUICIDE. 595 

intemperate! The medical man who furnished the certifi- 
cate stated that he considered it a perfectly safe risk ; for, 
although he had occasional outbreaks, he did not think 
drinking had any bad effects upon his health. This case 
shows what fallacious views are entertained by even medical 
men upon this subject. 

While we must admit that there are a few exceptional 
cases of persons who are habitual moderate drinkers living 
to old age, and enjoying apparent uninterrupted health, we 
cannot be blind to the fact that habitual dram-drinking does 
certainly and gradually impair the health, inducing dropsy, 
and organic disease of the liver and kidneys, which unques- 
tionably tend to shorten life. The few exceptional cases 
only prove the general rule. 

If a true representation of the temperate habits of the 
insured was made at the time of application, and he 
should subsequently fall into habits of intemperance, this 
would be no bar to a recovery upon the policy. 

The above general principles will serve also as a guide in 
cases of the opium habit. A concealment of the fact that 
the applicant was addicted to opium eating, even although 
it might be alleged that this habit had not impaired his 
health, would, undoubtedly, be an obstacle to a recovery 
upon the policy. 

As regards the question whether insanity has a tendency 
to shorten life, and therefore whether the concealment of its 
existence in the applicant amounts to the ** concealment of a 
material fact," we believe that the almost uniform experi- 
ence of physicians is that it does tend to shorten life. More- 
over, there is in nearly every policy a direct question bear- 
ing upon this point, the company reserving to itself the 
right to reject the particular applicant thus affected. 

The relationship of suicide to life insurance is one of con- 



596 MEDICAL JURISPRUDENCE. 

siderable interest, and has been the source of frequent liti- 
gations. We think the principle by which any particular 
case is to be decided is perfectly clear — Was the suicide 
evidently the result of insanity, and did this insanity come 
on after the policy was taken out ? If so, then, clearly, the 
insured is entitled to recover, just as much so as if the 
suicide was caused by the acute delirium of a fever, or by 
arachnitis. But if it can be shown that the suicide was the 
result of a deliberately-formed purpose, with a motive 
sufficiently strong to impel to the act (such as to get rid of 
impending debts, or to bestow the insurance money upon 
the individual's family), then there was no insanity con- 
nected with the act, and the policy should be void, because 
the insured had voluntarily shortened his life {vid. ante, 
p. 592). A very suspicious circumstance in connection 
with these cases of suicide and life insurance is the fact that 
the deceased has rarely made more than one or two pay- 
ments on his premium, before committing the suicidal act. 

One of the most remarkable cases of this character, in 
which the question of suicide by strangulation was urged 
by the defence, is that of Col. Dwight, which was tried in 
Norwich, N. Y., in December, 1883. This gentleman had 
been involved in heavy pecuniary difficulties, through ex- 
tensive financial operations. A few months before his death 
he effected insurances on his life to the amount of three 
hundred thousand dollars, on which he had made one 
quarter's payment only before he died. He had been com- 
plaining some weeks before of chills, loss of appetite and 
sleeplessness ; but on the day of his death he was comfort- 
able, was up and dressed, saw company, and executed legal 
papers. About half-past eleven o'clock on that night, he 
was heard to gasp for breath by his attendant, who was in 
an adjoining room ; he immediately went to his aid, raising 



LIFE INSURANCE SUICIDE. 597 

him up, and then summoned his wife and other friends ; 
death occurred almost immediately afterwards. The ques- 
tion to determine was whether deceased had strangled him- 
self with a cord, or whether the death had resulted from 
an over-quantity of morphia which he had taken (about 
three grains throughout that day) by the advice of his phy- 
sician. To support the theory of suicide by strangulation, 
several highly respectable physicians testified to the presence 
of one or more distinct depressions around the neck, having 
all the characters attendant on the usual marks of a con- 
stricting cord. These marks were attempted to be explained 
away by attributing them to the folds of the skin of the 
neck due to the bending of the neck in the ice box. But 
they were also noticed several months later, on the exhu- 
mation of the body. On the side of the plaintiff, it was 
alleged that the death was due to heart exhaustion, precipi- 
tated by the overdose of morphia. No testimony (singular 
to say) was taken from the persons who were witnesses of 
the death, save the one who sat up with him, and this man 
said nothing about strangulation, but gave the idea of its 
being a natural death. The jury found for the plaintiff, thus 
ignoring the idea of a fraudulent suicide. But the insurance 
companies have appealed (See Phila. Med. News, Dec, 1883, 
and Jan., 1884). 



i 



APPENDIX. 



The Corpus Luteum. — Through an inadvertence, this sub- 
ject was omitted in the body of the work. 

The value of the corpus luteum, or the stellated cicatrix, 
as a diagnostic sign of pregnancy^ is materially lessened by 
the well ascertained fact that a similar body is formed in the 
ovary after each menstrual flow, or, more correctly speaking, 
after each discharge of a ripened ovum. The latter is 
usually termed a false corpus luteum, and it differs from the 
true corptis hcteuin of pregnancy in certain particulars, such 
as the shorter duration, the less complete development of 
the stellate structure and yellow color, and the absence of a 
central cavity. This is the general rule; and the reason 
usually assigned for the increased growth and development 
of the corpus luteum of pregnancy is the increased nutri- 
tion derived by the Graafian follicle, through the stimulus 
of impregnation. 

But the value of this " sign " is still further lessened by 
the fact that a corpus luteum has been found where there 
has been neither pregnancy nor menstruation. Dr. Tidy 
{Leg. Med., Vol. II) cites two illustrations of this last char- 
acter; one, that of a prostitute who was poisoned by prussic 
acid, who was neither pregnant nor menstruating, and in 
whom a fully-ripe corpus luteum was found after death. 
The other, a woman who died, aged forty-one, from gan- 
grene of a uterine fibroid ; the ovary contained a perfectly 
formed corpus luteum, resembling that of pregnancy. In 
both these cases the author very properly ascribes the 

599 



600 APPENDIX. 

abnormal development to the increased determination of 
blood to the part; his conclusion being, that " there may be 
pregnancy without the presence of a true corpus luteum, 
and also that bodies undistinguishable from true corpora 
lutea may be found where there has been no pregnancy, 
and in aged women long past the period when pregnancy 
was probable." 



INDEX. 



/Abdomen, wounds of, ns. 

Abortion, criminal, 441. 

means employed, 450. 
proofs of, 442. 
feigned, 453. 
Abortives, 451. 
Abstinence from food, 175. 
Accelerators of putrefaction, 42, 52. 
Acetate of Lead, 287. 
Acetic acid, 314. 
Acid, arsenious, 238. 

arsenic, 260, 

carbolic, 315. 

meconic, 336. 

hydrochloric, 211. 

hydrocyanic, 397. 

nitric, 207. 

oxalic, 308. 

sulphuric, 204. 
Aconite, poisoning by, 390. 
Aconitine, 392. 
Aconitum napellus, 390. 
Adipocere, 50. 
^thusa cynapium, 389. 
Affiliation, 506. 
Age of newborn child, 449, 

of foetus, 447. 

of skeletons, 79. 

deduced from teeth, 80. 

for legal responsibility, 506. 
Air, influence on putrefaction, 43. 
Alcohol, poisoning by, 341. 
Alkahes, poisoning by, 215. 
Allopropic phosphorus, 233. 
Amentia, 542. 

Ammonia, poisoning by, 215. 
Anaesthetics, 345. 
Anaesthesia in rape, 523. 
Analysis, chemical, 191. 
Animal food, noxious, 329, 
Animal irritants, 325. 
Antagonism of poisons, 184. 
Antimony, poisoning by, 262. 
Apparent death, 29. 
Aqua fortis, 207. 
Areola of the breasts, 435. 
Arsenic, poisoning by, 238. 

antiseptic power of, 244. 

acid and arsenates, 260. 
Arsenite of copper, 260. 
Arsenuretted hydrogen, 248. 
Artificial inflation of lungs, 464. 
Asiatic cholera, mistaken for poisoning. 
Asphyxia, varieties of, 141. 
Atelectasis of lungs, 466. 
Atropa belladonna, 373. 
Atropia, 374. 
Auscultation in pregnancy, 438. 



B. 



ABY farming, 482. 
Balls, apertures made by, 108. 
Ballottement in pregnancy, 437. 
Barium, salts of, 223. 
Bean, calabar, 394. 
Belladonna, poisoning by, 273. 
Bestiality, 532. 
Bichloride of mercury, 273. 
Binoxalate of potassium, 314. 
Bichromate of " 307. 

Birth, concealment of, 456. 

pooofs of a live, 457. 

premature, 447, 501. 

protracted, 498. 
Bismuth, poisoning by, 305. 
Bitter almonds, oil of, 408. 
Bittersweet, poisoning by, 378. 
Black drop, 331. 

hellebore, 320. 
Bladder, rupture of, 119. 
Blisters from burns and scalds, 135. 
Blood, coagulation of, 95. 

stains, detection of, 121. 
human and animal, 128. 
crystals, 130. 
Blows or falls, injuries by, 96, 100. 
Body, putrefaction of, 41. 
Bones, human and animal, 78. 

age of, 87. 

identification of, 78. 
Born alive, meaning of, 456, 502. 
Brain, injuries of, 114. 
Breasts, changes of, in pregnancy, 435. 
Brucia, poisoning by, 371. 
Bullets, deflection of, 109. 
Buoyancy of the body, 163. 
Burns and scalds, death from, 137. 



^-»ADAVERIC alkaloids, 416. 

rigidity, 35. 

lividity, 39. 

spasm, 38. 
Csesarean extraction, 497. 
Calabar bean, 394. 
Caloricity, post-mortem, 34. 
Cantharides, poisoning by, 325. 
Cantharidin, 325. 
Capacity, testamentary, 568. 
Carbolic acid, poisoning by, 315. 
Catamenia, 433. 
Caustic poisons, 202, 215. 
Cerebrum, in insanity, 563. 
Certificates of insanity, 566. 
Cheese, poisoning by, 327. 
Chemical analysis, 191. 
Cherry-laurel water, 408. 
Chest, wounds of, 118. 



601 



602 



INDEX. 



Chest, examination of, in cases of infanti- 
cide, 489. 
Child murder, 455. 
Chloroform, poisoning by, 346. 
Cholera, mistaken for poisoning, 188. 
Chromium, poisoning by, 307. 
Chronic poisoning, 240, 276, 289, 296. 
Cicatrices, identification by, 73. 
Cider poisoned by lead, 286. 
Circumstantial evidence, 197. 
Civil responsibility, 537. 
Clothing, stains of, loi. 

stabs in, 102. 
Coagulation of the blood, 95. 
Cocculus Indicus, 413. 
Colchicum, poisoning by, 318. 
Cold, death from, 171. 
Coldness of the body in death, 32. 
Colic, painters', 289. 
Colica pictonum, 289. 
Colchicum, effects of, 318. 
Colostrum, 472, 492. 
Coma, death by, 26. 
Combustion, spontaneous, 139. 
Commissions of lunacy, 566. 
Compression of brain, 115. 

of and by the umbilical cord, 474. 
Concealed sex, 511. 
Concealment of pregnancy, 493. 

of delivery, 493. 

of birth, 493. 

of habits, in life insurance, 592. 
Conception, date of, 497. 
Concussion of brain, 114. 

of spinal marrow, 117. 
Confessions in drunkenness, 551, 
Conia, 387. 

Conium maculatum, 386. 
Contracts, 582. 
Contused wounds, 94. 
Contusions on the living and the dead, 96. 
Cooling of body after death, 32. 
Copper, poisoning by, 294. 
Copperas, poisoning by, 307. 
Cord, umbilical, 470, 474. 

mark of, in strangulation, 147. 
" in hanging, 153. 
Coroner, the, 12. 

inquests, 13. 
Corpus luteum, 417, 599. 
Corrosive poisons, 202, 215. 
Corrosive sublimate, 274. 
Counsel, in trials, 15. 
Courtesy, tenancy by, 504. 
Cranium, fractures of, 115. 
Criminal abortion, 441. 

responsibility, 571. 
Cross-examination, 16. 
Croton oil, poisoning by, 317. 

tiglium, 317. 
Crying, evidence from, 503. 
Crypsorchides, 512. 
Cuts and stabs, 99. 
Cyanide of silver, 401. 
Cytisine, 415. 
Cytisus laburnum, 415. 



L^ATE of conception, 498. 
Datura stramonium, 376. 
Daturine, 377. 
Dead, wounds and contusions of, 95. 

body, examination of, 56. 
Death, varieties of, 25. 

phenomena and signs of, 29. 

presumption of, 63. 

violent, causes of, 92. 
Deaf and dumb, 429. 
Debility, a cause of death, 476, 
Delirium tremens, 551. 
Defloration, 516. 
Deformities, evidence from, 85. 
Delivery, signs of, 491. 

feigned, 493. 

unconscious, 487. 
Delusions, 539. 
Dementia, 558. 
Development of foetus, 447. 
De ventro inspiciendo, 432. 
Diaphragm, position of, 460, 489. 
Diffusion of poisons, 180. 
Digitalis, poisoning by, 409. 
Digitaline. 411. 
Dipsomania, 550. 
Discharge of lunatics, 568. 
Diseased flesh, poisonous, 329. 
Disease, influence of, 42. 
Divorce, legal grounds for, 514. 
Docimasia pulmonum, 462. 
Doubtful sex, 510. 
Douglass peerage case, 507. 
Dress, examination of the, 57, loi. 
Drowning, death from, 156. 

signs of, 159. 
Drunkenness, responsibility, 550. 
Ductus arteriosus, 469. 

venosus, 470. 
Dulcamara, effects of, 378. 
Dying declarations, 23. 



t-CCENTRICITY not insanity, 569. 

Ecbolics, 451. 

Eczema from arsenic, 241. 

Effusion of blood, 96. 

Embryo, 417. 

Emerald green, poisoning by, 261. 

Emetic, tartar, 262. 

Emphysema of the lungs, 466. 

Epilepsy, 565, 569. 

feigned, 425, 
Epispadia, 511. 
Ergot, 451. 
Erotomania, 546. 

Erysipelas, following wounds, 112. 
Eserine, 395, 
Essence of mirbane, 409. 
Essential oil of almonds, 408. 
Ether, poisoning by, 345. 
Evidence, medical, 12, 17. 

of poisoning, 186. 
Examination in chief, 16. 

cross, 16. 

of wounds, 58, 94. 

of weapons, 99. 



INDEX. 



603 



Examination of blood stains, i 

of lunatics, 566. 
Experts, medical, 17. 
Exposure, death from, 480. 
Extra-uterine conception, 509. 
Extravasation of blood, 96. 



I ACE, wounds of, 117. 
Family liiceness, evidence from, 507. 
Farina, in stomach of new-born child, 472. 
Fasting, continued, 175. 
Fatality in wounds, 93. 
Features, evidence from, 507. 
Fecundation, 500. 
Fees, medical, claim for, 18. 
Feigned abortion, 453. 

dehvery, 493. 

diseases, 419. 

insanity, 576. 

wounds, 429. 

deafness and dumbness, 429. 
Felo dese, 553, 595. 
Flesh, diseased, 329. 
Fcetal circulation, 468. 

vessels, changes in at birth, 469. 
Foeticide, 441. 
Foetus, character of, 447. 
Food, poisonous, 326. 
Foramen ovale, 469. 
Fowler's solution, 260. 
Foxglove, poisoning by, 409. 
Fractures, identity from, 85. 

in newborn children, 478. 
Fungi, poisonous, 322. 



VJALL bladder, wounds of, 
Gardner peerage case, 499. 
Garotting, 146. 
Gases of putrefaction, 46. 
Gelsemium sempervirens, 322. 
Gestation, normal period, 497. 

protracted, 498. 

premature, 501. 

legal decisions, 502. 
Gonorrhoea in rape, 520. 
Guaiacum test for blood, 124. 
Guelder rose, 415. 
Gunpowder, wounds from, no 
Gunshot wounds, 107. 



H 



ABIT, influence of in poisoning, 186. 
Habits, concealed, 593. 
Haemoglobin, 122. 
Hematin, 122. 
Hair, identification of, 89. 

dyes, 90. 
Hallucinations, 538. 
Hands, wounds of the, 430. 
Hanging, death by, 151. 

signs of, 152 
Head, wounds of, 114. 
Heart, wounds of, 118. 
Heat, a cause of death, 170. 
Hellebore, poisoning by, 320. 
Hemlock, poisoning by, 386. 



Henbane, poisoning by, 377. 
Heredity in insanitj', 556. 
Hermaphroditism, 510. 
Homicidal wounds, 103. 

mania, 552. 
Human bones, 78. 
Hybernation, 30. 
Hydatids, uterine, 443 
Hydrate of chloral, 349. 
Hydrochloric acid, 211, 
Hydrocyanic acid, 397. 
Hydrostatic test, 462. 
Hymen, evidence from, 528. 
Hyoscyamus, poisoning by, 377. 
Hyoscyamia, 378. 



Identity, personal, 69. 

of the living, 70. 

of the dead, 76. 
Idiocy, 542. 

Idiosyncracy in poisoning, 178. 
Illusions, 537. 
Imbecility, 543. 
Immaturity of the foetus, 447. 
Impotence, 511. 

Impregnation, unconscious, 439. 
Imputed wounds, 429. 
Incised wounds, 99. 
Indian tobacco, 385. 
Infanticide, 455. 

proofs of live birth, 457. 
Infantile leucorrhoea, 520. 
Inflation of lungs, 464. 
Inheritance, 502. 
Inquests, coroner's, 12. 
Insanity, 535. 

medico-legal questions, 566. 

post-mortem signs, 561. 

feigned, 576. 
Inspection of the body, 56. 
Insurance, life, 591. 
Intellectual insanity, 545. 
Intemperance in relation to life insurance, 
^ 594- 

Interments, premature, 29. 
Intestines, wounds of, 119. 
Intoxication, distinguished from concussion, 

114. 
Iodine, poisoning by, 234. 
Iron rust on weapons, 124. 
Irritability, muscular, 36. 
Irritant poisons, 202. 



J ESSAMINE, yellow, 322. 
Juniperus sabina, 452. 
Jury of matrons, 432. 



K, 



lESTINE in the urine, 436. 
King's yellow, 247. 
Kleptomania, 549. 



L-ABOR, premature, 441 
Laburnum, 415. 
Lacerated wounds, 100. 



60^ 



INDEX. 



Laudanum, 331. 

Lead, poisoning by, 285. . 

Legitimacy, 496. 

Leucorrhoea, infantile, 455. 

Levant nut, 394. 

License of counsel, 15, 

Life insurance, 591. 

Lightning, death from, 166. 

Likeness, parental, 507. 

Linen, microscopic appearance, 90. 

Live birth, 458, 502. 

proofs of, 458. 
Liver, wounds of, 119. 
Lividity, cadaveric, 39. 
Lobelia inflata, 385. 
Lobelina, 385. 
Lochia, 491. 
Locomotion after injuries of the head, 103, 

after poisoning, 399. 
Lucid intervals, 541. 
Lunacy, commissions of, 566. 
Lungs, wounds of, 118. 

examination of, in newborn children, 482. 



M 



AJORITY and minority, 506. 
Malpraxis, medical, 582. 
Malformations, 504. 
Mania, 545 

homicidal, 552. 

suicidal, 553. 

feigned, 579. 
Marsh's test, 248. 
Marks of blood, 121. 

of tattooing, 73. 
Maternity, early, 439. 
Matrons, jury of, 432. 
Maturity of, newborn children, signs of, 449, 

Meconium, 472. 

Mechanical irritants, 179. 

Meconic acid, 336. 

Medical evidence, 15. 

Medical experts, 17. 

Medical jurisprudence, 9. 

Medical responsibility, 582. 

Medico-legal reports, 62. 

Melancholia, 546. 

Membrana pupillaris, 448. 

Menstruation, 433. 

Menstrual blood, 433. 

Mercury, poisoning by, 273. 

Microscopic evidence in blood stains, 126. 

in rape, 529. 
Milk, detection cf, in stomach, 472. 
Mind, unsoundness of, 535. 
Mineral acids, poisoning by, 202. 
Mirbane, essence of, 409. 
Miscarriage, 441. 
Moles in pregnancy, 443. 
Monk'shood, poisoning by, 390. 
Monomania, 549. 

homicidal, 552. 

suicidal, 553. 
Monorchides, 512. 
Monsters, 504. 
Morphia, 334. 
Moral insanity, 547. 



Mortality of wounds, iii. 

Mother, examination of, 444, 490. 

Motives for crime, 536. 

Muco-purulent discharges, 521, 527. 

Muriatic acid, 211. 

Muscular irritability after death, 37. 

Mushrooms, poisonous, 322. 

Mussels, poisonous, 328. 

Mutilated bodies, identification of, 76. 



N. 



^VI, identification by, 73. 
Narcotics, 330. 

Neck, twisting of in newborn children, 483. 
Neurotic poisons, 330. 
Nicotina, 382. 
Nitre, death from, 220. 
Nitric acid, 207. 
Nitro-benzole, 409. 
Noma pudendi, 521. 
Notes of autopsy, 62. 
Nux vomica, poisoning by, 351. 



CE, 



NANTHE crocata, 389. 
Oil of savin, 452. 
of tansy, 452. 
Opium, poisoning by, 330. 
Ordeal bean, 394. 
Orpiment, 261. 

Osmosis of poisons after death, 193. 
Osseous deposits in brain, 565. 
Ossification, a test of age of newborn child, 

„ 449- 

Ovum, 447, 500. 
Oxalic acid, 308. 



r AINTERS' colic, 289. 

Palsy from lead, 290. 

Paper hangings, arsenic in, 240. 

Paralysis, feigned, 427, 

Parental likeness, 507. 

Parkman-Webstercase, 76. 

Paternity, 506. 

Perforation of stomach, i88, 203, 

Personal identity, 69. 

Phosphorus, poisoning by, 224. 

Phosphorous acid, 226. 

Phosphoric acid, 233. 

Plea of pregnancy, 432. 

Ploucquet's test, 462. 

Poisons, definition, 178. 

mode of action, 180. 

absorption, 180. 

elimination, 181. 

evidences of, i86. 

post-mortem imbibition of, 193. 

toxicological examination of, 195. 
Poisoned flesh, 329. 
Poisonous food, 326. 
Policy, life insurance, 591. 
Post-mortem examination, 56. 
Potash and salts, 215. 
Pregnancy, 432. 

signs of, 433. 

concealed, 493. 

feigned, 432. 



INDEX. 



605 



Pregnancy in the dead, 440. 

precocious, 439. 

unconscious, 439. 
Premature burials, 29. 

labor, 441. 
Presumption of death, 63. 
Pretended fasting, 175. 
Procreative power, 512. 
Protracted gestation, 497. 
Prussic acid, 397. 
Ptomaines, 416. 
Ptyalism, mercurial, 276. 
Puberty, 512. 
Puerperal mania, 557. 
Punctured wounds, 98. 
Purulent discharges, 520, 527. 
Putrefaction, 41. 

evidences, 45. 

order of, 46. 
Putrescent food, 329. 
Pyromania, 550. 



R, 



APE, 516. 

anaesthesia in, 523. 

legal points, 532. 

on adults, 522. 

on children, 518. 
Red phosphorus, 233. 
Re-examination, 16. 
Reinsch's test, 251. 
Respiration, a sign of life, 458. 
Responsibility, civil and criminal, 571 

medical, 582. 
Rigidity, cadaveric, 35. 
Rigor mortis, 35. 
Rupture of viscera, 94. 
Rust, mistaken for blood, 124. 



OaLIVATION, mercurial, 276. 
Salt of sorrel, 314. 

of lemons, 314. 
Sausage poison, 327. 
Savin, oil of, 452. 
Scalds and burns, 134. 
Scalp, wounds of, 114. 
Scars, 70, 76. 
Scheele's green, 260. 

prussic acid, 398, 
Schweinfurt's green, 261. 
Self delivery, 475, 486. 
Self-inflicted wounds, 429. 
Seminal stains, 529. 
Senile dementia, 559. 
Sex, determination of, in the skeleton, 83. 

doubtful, 510. 

concealed, 511. 
Sexual malformation, 512. 
Shock, death from, 112. 
Shot, wounds made by, 109. 
Silk, microscopic appearance, 91. 
Silver, cyanide of, 401. 
Skeletons, identity of, 77. 

date of interment, 87. 

age of, 79. 

sex of, 83. 

stature of, 84. 



Skin of newborn children, 448, 457. 
Skull, evidences from, 78. 
Sleep, pregnancy during, 439. 

rape during, 523. 
Slow poisoning, 240. 
Smothering, death by, 144, 485. 
Soda and its salts, 215. 
Sodomy, 532. 
Softening of stomach, 191. 

of brain, 559. 
Solania, 379. 

Solanum dulcamara, 378, 
Somnambulism, 551. 
Sorrel, salt of, 314. 
Specific gravity of lungs, 462. 
Spectral analysis, 131. 
Spermatozoa, 529. 
Spine, concussion of, 117. 
Spontaneous combustion, 139. 
Stabs and cuts, 99, 103. 
Starch, detection of, 472. 
Starvation, death by, 175. 

pretended, 175. 
Stas' process, 367. 
Static test, 461. 
Sterility, 513. 
Still births, 455. 
Stomach, redness of, 191. 
Stomach, ulceration of, 191. 

mode of examination, 61, 189. 
Stramonium, poisoning by, 376. 
Strangulation, 146. 

signs of, 147. 

accidental, by the umbilical cord, 474. 
Strychnia, poisoning by, 351. 

evidences of, 352. 

detection of, 360. 
Sublimate, corrosive, 274. 
Subnitrate of bismuth, 305. 
Subpoenas, T5. 
Sudden death, 12. 

delivery, 479. 
Suffocation, death by, 143, 

signs of, 145. 

of newborn children, 483. 
Sugar, detection of, in foetal stomach, 472. 
Sugillation, 39. 
Suicide, 554. 
Suicidal mania, 553. 

wounds, 103. 
Sulphide of arsenic, 261. 
Sulphuric acid, 204. 
Sunstroke, 170. 
Superfoetation, 508. 
Surgical operations, 113. 

responsibility in, 588. 
Survivorship, 64, 
Syncope, a cause of death, 26. 
Syphilitic insanity, 565. 



I ANNER, Dr., fast of, 175. 
Tartar emetic, 262. 
Tartaric acid, 314. 
Tattoo marks, 73. 
Teeth, a test of age, 79. 

identity from, 82. 
Tenancy by courtesy, 504. 



606 



INDEX. 



Testamentary capacity, 568. 
Tetanus from wounds, 112. 
Tin, poisoning by salts of, 306. 
Tobacco, poisoning by, 380. 
Trichinosis, 327. 
Tumors, in brain of insane, 565, 



u 



LCERATION and corrosion, 191. 
Umbilical cord, 470. 

condition of, in dead and live born chi 
dren, 470. 
Unconscious delivery, 493. 

pregnancy, 439. 

intercourse, 439. 
Unsoundness of mind, 535. 
Uterus, changes of, in pregnancy, 445. 



V. 



AGINA, wounds of, 444. 

dilatation of, in rape of children, 519. 
Vaginitis in children, 520. 
Vagitus uterinus, 463. 
Vegetable irritants, 308. 
Ventre de inspiciendo, 432. 
Veratria, poisoning by, 321. 
Vertebrae, fractures of, 117, 483. 
Viability of the child, 502, 
Virginity, signs of, 528. 
Volition, loss of, by anaesthesia, 525. 
Vulval penetration, 519. 



w, 



ADDING, wounds by, no. 
Wallpapers, arsenical, 261. 
Water, influence of, on putrefaction, 44. 

action of, on lead, 286. 

hemlock, 389. 
Weapons, connection of, with wounds, 99. 

examination of, 93. 
Webster, Dr., case of, 76. 
Weight of newborn child, 450. 

of brain of newborn child, 449. 

of lungs at birth, 461. 
Welsh fasting girl, case of, 175. 
White lead, 289. 

hellebore, 321. 
Wills, capacity for making, 568. 
Witnesses, medical, 15. 
Wool, microscopic appearance, 91. 
Wounds, death from, 92. 

variety of, 95. 

cause of death by, in. 

made before and after death, 95. 

self inflicted, 429. 

of difl:erent parts of body, 114. 

from gunpowder, no. 

on newborn children, 482. 

Y ELLOW arsenic, 261. 
fc-INC, poisoning by, 301. 



CATALOGUE No. 7. 




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No. 10. ORGANIC CHEMISTRY. 

JUST PUBLISHED. 

A Compend of Organic Chemistry, including Medical 
Chemistry, Urine Analysis, and the Analysis of Water, 
and Food, etc. By Henry Leffmann, m.d., Pro- 
fessor of Clinical Chemistry and Hygiene in the Phila- 
delphia Polyclinic ; Professor of Chemistry, Penn- 
sylvania College of Dental Surgery ; Member of the 
N, Y. Medico-Legal Society. Cloth, ^i.oo. 

Interleaved, for the addition of Notes, ^1.25. 

Nature of Organic Bodies. Transformations under various con- 
ditions. Organic Synthesis. Homologous and Isomeric Bodies, 
Empirical and Rational formula;. Classification of organic bodies. 
Hydrocarbon. Derivatives of Hydrocarbons, Alcohols and Ethers. 
Benzenes and Turpenes. Fat Acids, Oils and Fats, Sugars, Gluco- 
sides. Cyanogen Compounds Amines and Amides. Alkaloids. 
Ptomaines. Animal Chemistry. Nutrition and Assimilation. 
Food, Water and Air. Urinary Analysis. Index. 



The Essentials of Pathology. 

BY D. TOD GILLIAM, M.D., 

Professor of Physiology in Starling Medical College, Columbus, O. 

With 47 Illustrations. 12mo. Cloth. Price $2.00. 

***The object of this book is to unfold to the beginner the funda- 
mentals of pathology in a plain, practical way, and by bringing them 
within easy comprehension to increase his interest in the study of 
the subject. Though it will not altogether supplant larger works, 
it will be found to impart clear-cut conceptions of the generally 
accepted doctrines of the day, and to prevent confusion in the mind 
of the student. 



A POCKET-BOOK OF 

PHYSICAL DIAGNOSIS 

OF THE 

Diseases of ihe Heart and L ungs. 

A MANUAL FOR STUDENTS AND PHYSICIANS. 

BY DR. EDWARD T. BRUEN, 

Demonstrator of Clinical Medicine in the University of Pennsyl- 
vania, Assistant Physician to the University Hospital, etc. 

Second Edition, Revised. With new illustrations. 12mo. $1.50. 

*:i:*The subject is treated in a plain, practical manner, avoiding 
questions of historical or theoretical interest, and without laying 
special claim to originality of matter, the author has made a book 
that presents the somewhat difficult points of Physical Diagnosis 
clearly and distinctly. 



STUDENTS' MANUALS. 



TYSON, ON THE URINE. A Practical Guide to 
the Examination of Urine. For Physicians and Stu- 
dents. By James Tyson, m.d.. Professor of Path- 
ology and Morbid Anatomy, University of Pennsylva- 
nia. With Colored Plates and Wood Engravings. 
Fourth Edition. i2mo, cloth, ^1.50 

HEATH'S MINOR SURGERY. A Manual of 
Minor Surgery and Bandaging. By Christopher 
Heath, m.d.. Surgeon to University College Hospital, 
London. 6th Edition, 115 111. i2mo, cloth, ^2. 00 

REESE. A MANUAL OF MEDICAL JURIS- 
PRUDENCE and Toxicology, for Students and 
Physicians. Small 8vo, 550 pages. 

VIRCHOW'S POST-MORTEMS. Post-Mortem 
Examinations. A Description and Explanation of the 
Methods of Performing them. By Prof. Rudolph 
ViRCHOW, of Berlin. Translated by Dr. T. B. Smith. 
2d Ed. 4 Lithographic Plates. i2mo, cloth, ^1.25 

DULLES' ACCIDENTS AND EMERGEN- 
CIES. What To Do First in Accidents and Emer- 
gencies. A Manual Explaining the Treatment of 
Surgical and other Accidents, Poisoning, etc. By 
Charles W. Dulles, m.d.. Surgeon Out-door De- 
partment, Presbyterian Hospital, Philadelphia. Col- 
ored Plate and other Illustrations. 32mo, cloth, .75 

BEALE, ON SLIGHT AILMENTS. Their Na- 
ture and Treatment. By Lionel S. Beale, m.d., 
f.r.s. Second Edition. Revised, Enlarged and Illus- 
trated. 283 pages. 8vo. 

Paper covers, 75 cents; cloth, #1.25 

ALLINGHAM, ON THE RECTUM. Fistulae, 
Hemorrhoids, Painful Ulcer, Stricture, Prolapsus, and 
other Diseases of the Rectum ; Their Diagnosis and 
Treatment. By Wm. Allingham, m.d. Fourth Re- 
vised and Enlarged Edition. Illustrated. 8vo. 

Paper covers, 75 cents; cloth, ^^1.25 

THOMPSON, ON THE URINARY ORGANS. 
On Diseases of the Urinary Organs. By Sir Henry 
Thompson, M.D. , f.r.c.s. Seventh Edition. 84 Illus- 
trations. 8vo. Paper covers, 75 cents; cloth, ^1,25 



STUDENTS' MANUALS, 



MARSHALL AND SMITH, ON THE URINE. 

The Chemical Analysis of the Urine. By John Mar- 
shall, M.D., Chemical Laboratory, University of Penn- 
sylvania, and Prof. E. F. Smith. Illus. Cloth, ^i oo 

MEARS' PRACTICAL SURGERY. Surgical 
Dressings, Bandaging, Ligation, Amputation, etc. By 
J. EwiNG Mears, M.D., Demonstrator of Surgery in 
Jefferson Med. College. 227 Illus. 2d Ed. In Press. 

HOLDEN'S ANATOMY. A Manual of the Dis- 
section of the Human Body. Fifth Edition, Revised 
and Enlarged, with over 170 Illustrations. 

BLOXAM'S LABORATORY TEACHINGS. 
Progressive Exercises in Practical Chemistry. By Prof. 
C. L. Bloxam. 89 Illustrations. i2mo, cloth, $1.75 

TYSON, ON THE CELL DOCTRINE; its His- 
tory and Present State. By Prof. James Tyson, m.d. 
Second Edition. Illustrated. i2mo, cloth, ^2.00 

MEADOWS' MIDWIFERY. A Manual for Stu- 
dents. By Alfred Meadows, m.d. From Fourth 
London Edition. 145 Illustrations. 8vo, cloth, ^2.00 

WYTHE'S DOSE AND SYMPTOM BOOK. 
Containing the Doses and Uses of all the principal 
Articles of the Materia Medica, etc. Eleventh Edi- 
tion. 32mo, cloth, ^i.oo; pocket-book style, $1.25 

PHYSICIAN'S PRESCRIPTION BOOK. Con- 
taining Lists of Terms, Phrases, Contractions and 
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Grammatical Construction of Prescriptions, etc., etc. 
By Prof. Jonathan Pereira, m.d. Sixteenth Edi- 
tion. 32mo, cloth, ^i.oo; pocket-book style, ^1.25 

POCKET LEXICONS. 

CLEAVELAND'S POCKET MEDICAL LEXI- 
CON. A Medical Lexicon, containing correct Pro- 
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cine and the Collateral Sciences. Thirtieth Edition. 
Very small pocket size. Red Edges. 

Cloth, 75 cents; pocket-book style, ^i.oo 

LONGLEY'S POCKET DICTIONARY. The 
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ROBERTS' PRACTICE. 

Fifth Edition. 
Recommended as a Text-book at University of Pennsylvania, 
Long Island College Hospital, Yale and Harvard Colleges, 
Bishop' s College, Montreal, University of Michigan, and 
over twenty other Medical Schools. 
A HANDBOOK OF THE THEORY AND PRACTICE OF 
MEDICINE. By Frederick T. Roberts, m.d., m.r.c.p., 
Professor of Clinical Medicine and Therapeutics in University- 
College Hospital, London. Fifth Edition. Octavo. 

CLOTH, $5.00; LEATHER, $6.00. 
*:;:* This ncw edition has been subjected to a careful revision. 
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duced. 

"A clear, yet concise, scientific and practical work. It is a capi- 
tal compendium of the classified knowledge of the subject." — Prof, 
y. Adams Allen, Rush Medical College, Chicago. 

" I have become thoroughly convinced of its great value, and 
have cordially recommended it to my class in Yale College." — 
Prof. David P. Smith. 

" I have examined it with some care, and think it a good book, 
and shall take pleasure in mentioning it among the works which 
may properly be put in the hands of students." — A. B. Painter, 
Prof, of the Practice of Medicine, Utiversity of Michigan. 

" It is unsurpassed by any work that has fallen into our hands, 
as a compendium for students preparing for examination. It is 
thoroughly practical, and fully up to the times." — The Clinic. 

" Our opinion of it is one of almost unqualified praise. The 
style is clear, and the amount of useful and, indeed, indispensable 
information which it contains is marvelous." — Boston Medical and 
Surgical Journal. 

BIDDLE'S MATERIA MEDICA. 

Ninth Revised Edition. 
Recommended as a Text-book at Yale College, University of 
Michigan, College of Physicians and Surgeons, Baltimore, 
Baltimore Medical College, Louisville Medical College, 
and a number of other Colleges throughout the U. S. 
BIDDLE'S MATERIA MEDICA. For the Use of Students and 
Physicians. By the late Prof. John B. Biddle, m.d., Profes- 
sor of Materia Medica in Jefferson Medical College, Philadelphia. 
The Ninth Edition, thoroughly revised, and in many parts re- 
written, by his son, Clement Biddle, m.d., Past Assistant 
Surgeon, U. S. Navy, assisted by Henry Morris, m.d. 

CLOTH, $4.00; LEATHER, $4.75. 
" I shall unhesitatingly recommend it (the 9th Edition) to my 
students at the Bellevue Hospital Medical College. — Prof. 
A. A. Smith, New York, June, 1883. 

" The standard ' Materia Medica ' with a large number of medi- 
cal students is Biddle's." — Bujfalo Medical and Surgical Journal. 
" The larger works usually recommended as text-books in our 
medical schools are too voluminous for convenient use. This work 
will be found to contain in a condensed form all that is most valuable, 
and will supply students with a reliable guide." — Chicago Med. fl. 
*** This Ninth Edition contains all the additions and changes in 
the U. S. Pharmacopoeia, Sixth Revision. 



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BLOXAM'S CHEMISTRY. Inorganic and Organic, \vith Ex- 
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CARPENTER ON THE MICROSCOPE and Its Revelations. 
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DRUITT'S SURGERY, A Manual of Modern Surgery. Elev- 
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FLOWER, DIAGRAMS OF THE NERVES of the Human 
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GALLABIN'S MIDWIFERY. A Manual for Students. lUus- 

' trated. In Preparation. 

GLISAN'S MODERN MIDWIFERY. A Text-book. 129 
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HOLDEN'S ANATOMY and Manual of Dissections of the 
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HOLDEN'S OSTEOLOGY. A Description of the Bones, with 
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HEATH'S PRACTICAL ANATOMY and Manual of Dissec- 
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HEADLAND, THE ACTION OF MEDICINE in the System. 
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KIRKE'S PHYSIOLOGY. A Handbook for Students. Tenth 
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MANN'S PSYCHOLOGICAL MEDICINE and Allied Ner- 
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MACNAMARA ON THE EYE. A Manual for Students and 
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WILSON'S HUMAN ANATOMY. General and Special, 
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HARLEY ON THE LIVER. Diagnosis and Treatment. Col- 
ored Plates and other Illustrations. Svo, cloth, $5.00 ; sheep, $9.00 



AE^An Encyclopedia of Medical Knowledge. °=®|l 

INDEX OF DISEASES; 

WITH TREATMENT AND FORMULA. 

By THOS. HAWKES TANNER, M.D. 

REVISED AND ENLARGED BY DR. BROADBENT. 

Octavo, Cloth. Price $3.00. 

*** The worth of a work of this kind, by so eminent a professor 
as Dr. Tanner, cannot be over-estimated. As an aid to physicians 
and druggists, both in the country and city, it must be invaluable. 
It contains a full list of all diseases, arranged in alphabetical order, 
with list of formulae, and appendix giving points of interest regard- 
ing health resorts, mineral waters, and information about cooking 
and preparing food, etc., for the invalid and convalescent. The 
page headings are so indexed that the reader is enabled to find 
at once the disease wanted; its synonyms, classification, varie- 
ties, description, etc., with the course of treatment recommended 
by the best authorities, and is referred, by number, to the several 
prescriptions that have proved most efficacious. These prescrip- 
tions are also arranged so that they can be easily referred to, with 
directions how to use them, when to use them, and what diseases 
they are generally used in treating. The directions for cooking 
foods and preparing poultices, lotions, etc., are very full. The 
work will be found specially useful to students and young physicians. 

RICHTER'S CHEMISTRY, 

A TEXT-BOOK of INORGANIC CHEMISTRY for STUDENTS. 
By PROF. VICTOR von RICHTER, 

University of Breslau, 
Authorized Translation from the Third German Edition, 

By EDGAR F. SMITH, M.A., Ph.D., 
Professor of Chetnistry in Wittenberg' College, Springfield, Ohio; 

formerly in the Laboratories of the Ujiiversity of Pennsyl- 
vania: Mej7iber of the Cheinical Society of Berlin. 
12mo. 89 Wood-cuts and Col. Lithographic Plate of Spectra. $2.00 

In the chemical text-books of the present day, one of the striking 
features and difficulties we have to contend with is the separate 
presentation of the theories and facts of the science. These are 
usually taught apart, as if entirely independent of each other, and 
those experienced in teaching the subject know only too well the 
trouble encountered in attempting to get the student properly in- 
terested in the science and in bringing him to a clear comprehension 
of the same. In this work of Prof, von Richter, which has been 
received abroad with such hearty welcome, two editions having 
been rapidly disposed of, theory and fact are brought close together, 
and their intimate relation clearly shown. From careful observa- 
tion of experiments and their results, the student is led to a correct 
understanding of the interesting principles of chemistry. The de- 
scriptions of the various inorganic substances are full, and embody 
the results of the latest discoveries. 

In preparation, "ORGANIC CHEMISTRY," By the same 
author. Translated. 



BYFORD, DISEASES OF WOMEN. 

NEW REVISED EDITION. 
The Practice of Medicine and Surgery, as applied to the 
Diseases of Women, By W. H, Byford, A.m., m.d,, 
Professor of Gynaecology in Rush Medical College; 
of Obstetrics in the Woman's Medical College ; Sur- 
geon to the Woman's Hospital; President of the 
American Gynaecological Society, etc. Third Edition. 
Revised and Enlarged; much of it Rewritten; with 
over 1 60 Illustrations, Octavo. 

PRICE, CLOTH, $5.00; LEATHER, $6.00. 
" The treatise is as complete a one as the present state of our 
science will admit of being written. We commend it to the diligent 
study of every practitioner and student, as a work calculated to in- 
culcate sound principles and lead to enlightened practice." — New 
York Medical Record. 

" The author is an experienced writer, an able teacher in his de- 
partment, and has embodied in the present work the results of a 
wide field of practical observation. We have not had time to read 
its pages critically, but freely commend it to all our readers, as one 
of the most valuable practical works issued from the American 
press." — Chicago Medical Examiner. 

DAY ON CHILDREN. Second Edition. 

The Diseases of Children. A Practical and Systematic 
Treatise for Practitioners and Students. By William 
H. Day, m.d,. Author of " Headaches ; Their Causes, 
Nature and Treatment ;" Member of the Royal College 
of Physicians of London ; Physician to the Samaritan 
Hospital for Women and Children, etc. Second Ed. 
Rewritten and very much Enlarged. 8vo. 752 pp. 

PRICE, CLOTH, $5.00; SHEEP, $6.00. 
" A careful examination of this book leads us to characterize it 
as a plain, straightforward treatise on the subject upon which it 
treats . . . giving sound practical advice." — Philad' a Med.Tiines. 
" On the whole, we must confess we are pleased with this book 
and can heartily recommend it — a recommendation which it does 
not appear to need, as it has already reached its second edition." — 
American yournal of Medical Science. 

MACKENZIE, THE THROAT AND NOSE. 

By MoRELL Mackenzie, m.d., Senior Physician to the 

Hospital for Diseases of the Chest and Throat; Lecturer 

on Diseases of the Throat at the London Hospital, etc. 

Vol. I, Including the Pharynx, Larynx, Trachea, 

etc. 112 Illustrations, Cloth, ^4,00; Leather, ^5.00 

Vol, II. Diseases of the CEsophagus, Nasal 

Cavities and Neck. Cloth, ^3.00; Leather, $4,00 

The two volumes at one time, Cloth, $6.00: Leather, $7.50 



YEO'S PHYSIOLOGY. 

A MANUAL FOR STUDENTS. JUST READY. 
300 CAREFULLY PRINTED ILLUSTRATIONS. 

FULL GLOSSARY AND INDEX. 
By Gerald F. Yeo, m.d., f.r.c.s., Professor of Physi- 
ology in King's College, London. Small Octavo. 7^0 
pages. Over 300 carefully printed Illustrations. 

PRICE, CLOTH, $4.00; LEATHER, $5.00. 

" By his excellent manual. Prof. Yeo has supplied a want which 
must have been felt by every teacher of physiology. * * * * 
In conclusion, we heartily congratulate Prof. Yeo on his work, 
which we can recommend to all those who wish to find within a 
moderate compass a reliable and pleasantly written exposition of 
all the essential facts of physiology as the science now stands." — 
The Dubiifi yonrnal 0/ Med. Science. 

"The work will take a high rank among the smaller text-books 
of Physiology." — Fro/. H. P. Bowditch, J^Iarvard Med. School, 
Boston. 

" The brief examination I have given it was so favorable that I 
placed it in the list of text-books recommended in the circular of 
the University Medical College." — Pro/. Lewis A. Stimpson, 
M. D. , 37 East 33d Street, Nezv York. 

" For students' use it is one of the very best text-books in Physi- 
o\ogy ."— Pro/. L. B. how, Dartmotitk Med. College, Hanover, 

RINDFLEISCH. 

THE ELEMENTS OF PATHOLOGY. 

TRANSLATED BY WM. H. MERCUR, M.D. 
REVISED AND EDITED BY PROF. JAS. TYSON, 

O/the University 0/ Pennsylvajiia. 
OCTAVO. CLOTH. NEARLY READY. 
^.j^"^ It is the object of Prof. Rindfleisch to present in 
this volume of moderate size the fundamental principles 
of Pathology A large number of the general processes 
which underlie disease, a knowledge of which is essen- 
tial to the practical physician, are plainly presented. 
They include, among others, inflammation, tumor forma- 
tion, fever, derangements of nutrition, including atrophy, 
derangements of the movement of the blood, of blood 
formation and blood purification, hyperaesthesia, anaesthe- 
sia, convulsions, paralysis, etc. The well-knowr _puta- 
tion of the author, his thorough familiarity with, and his 
method of treating the subject, make this most recent work 
peculiarly useful to the student, as well as to the prac- 
ticing physician who wishes to brush up his pathology. 



